Post-operation Effect Of The Fibroptic Pharyngoscopy In Patients With Obstructive Sleep Apena-hypopnea Syndrome

Objectives:The aim of this study is to investigate the correlationbetween narrowing rate in oropharynx and post-operation effect in patientswith obstructive sleep apnea-hypopnea syndrome,using computer assistingfiberoptic pharyngocopy with Müller maneuver (CFPMM).We recode thenarrowing rate during Müller maneuver and ESS score change rate toinvestigate the predictive value of CFPMM before UPPP.Methods:23patients confirmed by PSG as OSAHS were enrolled inthis study.Demographic data such as age,sex,weight and height wererecorded.Every subject underwent medical history and physical examinationin detail,and completed Epworth Sleepiness Scale questionnaire. computerassisting fiberoptic pharyngocopy with Müller maneuver(CFPMM) wasperformed to observe the narrowing site of upper airway in every subject,andchoose17from them who had only narrowing in oropharynx.Results:The PSG results of the subjects showed that the apnea-hypopnea index (AHI) and the lowest arterial oxygen saturation (SaO2)had significant correlation with the servirity of the disease.During thecomputer assisting fiberoptic pharyngocopy with Müller maneuver(CFPMM),all subjects had narrowing at oropharynx while6of them hadnarrowing at nasopharynx and/or hypopharynx,who were excluded from thisstudy.Classified the subjects by the narrowing rate into two groups, thenarrowing rate of14subjects was higher than75%with mean AHI66.67±15.04and SaO260.38%±10.17%,the other6were within25%to75%with mean AHI23.45±1.07and SaO281%±4.08%.There were significantdifference between the mean AHI and SaO2in the two groups.Classified thesubjects by the severity of OSAHS into three groups,2subjects (11.8%) inmild group(5<AHI≤20/H) had an average AHI of15.30±0.85/H andaverage minimum SaO283%±5.66%,and the mean preoperative ESS scorewas7.50±0.71, the average narrowing rate was57%±8.48, the meanpreoperative ESS score was3±0.2(11.8%) in moderate group (20<AHI≤40/H) had an average AHI of26.95±9.12/H, and the average minimumSaO2is75%±7.07%, the mean preoperative ESS score was10.50±0.71,theaverage narrowing rate was74%±12.73, the mean preoperative ESS scorewas4±1.41.13cases (76.4%) in severe group (AHI>40/H) had an averageAHI of67.39±23.64/H and the average minimum SaO2is61%±11.02%, the average preoperative ESS score was16.46±3.50, the average narrowing ratewas89.46%±8.06, the mean preoperative ESS score was5.23±1.30. AHI andthe lowest SaO2were negatively correlated (r=-0.77, p<0.001).The lowestSaO2in the three groups had significant difference (χ2=7.04, p=0.030), theaverage preoprative ESS score in the three groups also had significantdifference (χ2=8.85, p<0.05), the narrowing rate(χ2=7.78,p<0.05) and the ESSscore change rate also showed significant differences (χ2=6.93,p<0.05),however, no significant difference was found in postoperative ESSscore(χ2=5.18,p>0.05).Preoperative ESS score and AHI was positivelycorrelated (r=0.940, p<0.001), and negatively correlated with the lowestSaO2(r=-0.787, p<0.001).There were obviously positive correlation betweenthe narrowing rate and AHI(r=0.89,p<0.001) and negative correlationbetween narrowing rate and lowest SaO2(r=-0.74, p=0.001). In this study weadopted change rate of pre and postoperation ESS score as the evaluation ofUPPP effect.After adjusting age, BMI and neck circumstance and otherfactors, we found that narrowing rate was positively correlatd with ESS scorechange rate (Beta=0.85,p<0.001).Conclusion:1.Computer assisting fiberoptic pharyngocopy with Müllermaneuver (CFPMM) can directly find upper airway narrowing,anatomicalabnormalities and dysfunction in OSAHS patients.2．The compliance of pharyngeal wall in OSAHS patients increased, which made it easier tocollapse.The higher narrowing rate in oropharynx,the higher average AHIand the lower lowest SaO2would be found in PSG.So high rate of narrowingrate could indicate the OSAHS patient was more serious.3.There weresignificant correlation between oropharyngeal narrowing rate andpostoperative patients quality of life. Computer assisting fiberopticpharyngocopy with Müller maneuver (CFPMM) could predict thepreoperative effect in some degree.