Assessment Before Uvulopalatopharyngoplasty And Acoustic Change After Uvulopalatopharyngoplasty

PARTⅠCorrelation between subjective assessment and objective measurement of obstructive sleep apnea hypopnea syndromeObjective To investigate the correlation between subjective assessment and objective measurement of obstructive sleep apnea hypopnea Syndrome (OSAHS).To provide accurate and systematic assessment method before uvulopalatopharyngoplasty(UPPP).Method Data of 200 patients with OSAHS were collected retrospectively. Assessment of snoring was achieved by visual analogue scale(VAS) .Assessment of excessive daytime sleepiness was achieved by Epworth sleepiness scale(ESS).The quality of life was assessed by sleep apnea quality of life index(SAQLI).The association between the scores and polysomnography(PSG) parameters in OSAHS patients was examined statistically.Result①There was a significant correlation between VAS,ESS and SAQLI scores(P＜0.01);②VAS had significant correlation with apnea hypopnea index(AHI),lowest oxygen saturation(LSaO2),cumulative percentage of sleep time with SaO2 below 90%(CT90%) and the longest time of breathing disorder(BDLon)(r=0.4834,-0.4101,0.4316,0.3979,P＜0.0001),so ESS did(r=0.4215,-0.4106,0.3007,0.2899,P＜0.01).The mean of ESS or VAS in severe OSAHS group was higher than that in mild and mederate OSAHS groups,but no diference was found between the mild and moderate OSAHS groups.The mean of ESS or VAS in severe hypoxemia group was higher than that in no,mild and moderate hypoxemia groups,but no diference was found between no,mild and moderate hypexemia groups.③There was a mild correlation between several domains on the SAQLI and several PSG parameters.There was little correlation between SAQLI and the severity of OSAHS.Conclusion①Both ESS and VAS have significant correlation with the para meters of PSG,but there is no good correlation between SAQLI and PSG examination;In order to evaluate OSAHS patients before UPPP properly, both subjective assessment and objective examination must be considered.②Both ESS and VAS have little value in assessment of OSAHS.They can be a primary screening method only for suspected patients with severe OSAHS. PARTⅡEvaluation of ApneaGraph in the assessment before uvulopalatopharyngoplastyObjective ApneaGragh is a new device for simultaneous determination of obstructive sleep apnoeic events and continuous pressure measurements for localization of upper airway obstructive sites.This study is to evaluate the clinical value of ApneaGragh in the assessment before uvulopalatopharyngoplasty (UPPP).Method Thirty-nine patients diagnosed as obstructive sleep apnea hypopnea syndrome(OSAHS) underwent a PSG and an ApneaGraph study simultaneously 2 days before UPPP.ApneaGraph's results were correlated with both the Friedman staging system and polysomnography statistically.Result①There was a good correlation between measurements of AG and PSG for apnea hypopnea index(AHI) and lowest oxygen saturation(LSaO2) (r=0.8771,0.7946,P＜0.01);Except for hypopnea index(HI)(p=0.021) and mixed apnea index(AI)(p=0.002),our study showed no differences between PSG and AG for other parameters;The mean of AHI on back body position was higher than side body position(P＜0.05).②The%retropalatal obstruction was 79.91%,71.53%and 78.66%in stages 1,2 and 3, respectively.There was no significant difference between stages(P＞0. 05).Conclusion ApneaGraph can serve as a portable PSG to diagnose sleep disordered breathing qualitatively.In the meantime,it also can identify the level of upper airway obstruction.It seems that ApneaGraph may be used to select patients for UPPP widely. PARTⅢAssessment of acoustics after uvulopalatopharyngoplastyObjective To determine the effect of uvulopalatopharyngoplasty(UPPP) on the voice quality.Method Twenty-six adult patients diagnosed as obstructive sleep apnea hypopnea syndrome(OSAHS) underwent the UPPP.Researches on quality assessment of speech were made preoperatively(1 week) and postoperatively (about 6 months).Patients' subjective gradings included voice handicap index,voice-related quality of life and nasality questionnaires.The method of objective assessment was acoustic analysis of vowels.The preand postoperative articulation results were analysed statistically.Result No patient suffered from disorders such as hypernasality and articulation errors.No significant differences were found before and after UPPP regarding the questionaires' score,fundamental frequency and Intensity(P＞0.05).But several formants changed:the third formant frequencies(F3) in vowel[o],[e]and[u]decreased statistically,while the second formant(F2) in vowel[i]and the fourth formant(F4) in vowel [o]increased statistically(P＜0.05).Conclusion The findings of the study indicate that UPPP doesn't have a significant impact on daily speaking.But several formants changed, which is important in management of patients with concerns about postoperative vocal quality,such as singers and professional speakers.