Clinic Study Of Upper Airway Manometry In Determinning Obstructive Sties Of Patients With Obstructive Sleep Apnea Hypopnea Syndrome

Objective1.ApneaGragh is a new device for simultaneous determination of obstructive sleep apnoeic events and continuous pressure measurements for localization of upper airway obstructive site.This section is to evaluate the clinical value of it.2.To evaluate the efficiency of upper airway reconstructive surgery with the obstructive site determined by upper airway pressure measurement and to test the value of upper airway menometry in localization of obstructive sites. Methods1.(Part 1) From April to October in 2006,32 obstructive sleep apnea(OSA) patients diagnosed by polysomnography(PSG) were examined by two methods: Endoscopy with muller' s maneuver at daytime and continuous upper airway pressure recording with ApneaGraph at night in Peking Union Medical College Hospital.The upper airway obstructive sites determined by the two methods were compared.ApneaGraph transducer catheter contains two pressure sensors and two temperature sensors used for obstruction site determination and detection of apnoeic events during sleep.Obstructive sites were divided into upper(retropalatal oropharynx) or lower level(retroglossal region).The lower limit of upper airway obstruction was determined by observed pressure pattern.Used constituent retio to reflect the obstructive proportion of different levels.The apnea hypopnea index(AHI) measured by PSG and ApneaGraph were also compared.2.(Part2) Thirty seven moderate to severe OSAHS patients with their upper airway obstructive sites diagnosed by ApneaGraph pressure measurements underwent reconstructive surgery.All patients were divided into retropalatal or retroglossal obstructive groups according to the results of pressure measurements.Retropalatal group received uvulopalatopharyngoplasty(UPPP) and other palatinal level surgical approaches while retroglossal group underwent multilevel surgeries(uppp plus hyoid suspension or other tongue base surgeries).ApneaGraph and ESS were recorded at 6 to 13 months after surgery.Results1.(Part 1) Two patterns of obstruction were observed in our group:(1) The site of obstruction was located only at the upper level.(2) The obstruction of upper and lower level all present.Site of obstruction determined by Apneagraph:28(87.5%) cases had predominant sites of obstructions in upper level(the constituent retio of retropalatal obstruction )50%),the others in lower level(the constituent retio of retroglossal obstruction )50%). Endoscopy localization of obstruction:18 cases had retropalatal obstructions alone,13 cases had obstructions of retropalate combined with retroglossa,onlylpatientdidn'thaveobstruction.Defined the constituent retiohigher than thirty percent the criteria of obstruction,then identical results were obtained by both methods in retropalatea]segment in 27(84.4%) of the patients,while in only 17(53.1%) obstructions was determined by the both methods in retroglossal areas.The polysomnograpic AHI was 52.2±18.1,versus 50.2±16.0 obtained by ApneaGraph.There was a significant correlation between them(r=0.876,P＜0.001).2.(Part 2) Patients were 23 to 66(40.8±9.4) years old;34(92%) were male. There were statistically significance in all between preoperative and postoperative measurements(P＜0.001).Mean±SD AHI decreased from preoperative(54.20±2.56)to postoperative(15.37±3.00) events per hour and ESS decreased from preoperative(17.14±5.11) to postoperative(3.00±5).Improvement of desaturation index(ODI) was significant from preoperative(48.08±23.41) to postoperative(11.11±17.15) events per hour. Lowest oxygen saturation(LSaO₂) increased from preoperative 0.697±0.088 to postoperative 0.823±0.080.23 patients had primary obstructive level within the upper pharyngeal region while the other 14 cases within tongue base.The overall success rate(AHI＜20 and )50%reduction in AHI)was 78.38%. Retropalatal and retroglossal obstructive groups had their success rate 78.26%and 78.57%respectively.ConclusionUpper airway pressure measurement can identify the level of upper airway obstruction more accurate than fiberoptic pharyngoscopy.ApneaGraph can also serve as a portable PSG to diagnose sleep disordered breathing qualitatively.