Tıkayıcı uyku apnesi sendromunda burun cerrahisinin etkinliği
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Date
2010
Authors
Sufioğlu, Mansur
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalısmanın amacı, Tıkayıcı Uyku Apnesi Sendromu (TUAS) ve burun patolojisi olan hastalarda, mevcut olan burun patolojisine yönelik cerrahilerin TUAS ve sürekli pozitif havayolu basıncı (Continuous Positive Airway Pressure – "CPAP") titrasyonu üzerindeki etkisini polisomnografi (PSG) ile arastırmaktır. Aralık 2007 – Haziran 2010 tarihleri arasında polisomnografi (PSG) ile TUAS tanısı konulmus olan hastalar arasından obstrüktif burun patolojisi saptanan 34 hasta çalısmaya davet edildi. Düzeltici nazal cerrahiyi kabul etmeyen ve cerrahiye engel sistemik problemleri olan üç hasta çalısmaya alınmadı. Çalısmaya alınan 31 hasta Epworth uykululuk skalası (EUS), TUAS ve horlama görsel analog skalası (GAS) ile degerlendirildi. CPAP titrasyonu yapıldıktan sonra burun patolojisine yönelik cerrahi (septum cerrahisi n=25, konka girisimi n=26, sinüs cerrahisi ve polipektomi n=4, septorinoplasti n=2) uygulandı. Cerrahi tedaviden 3 ay sonra hastalar Epworth uykululuk skalası (EUS), TUAS ve horlama GAS'sı, PSG ve CPAP titrasyonu yapılarak tekrar degerlendirildi. Böylece, burun patolojilerinin TUAS üzerindeki etkinligi hem objektif hem de subjektif olarak arastırıldı. Ameliyat sonrası üç hasta yeniden PSG yaptırmak istemediginden çalısma dısı bırakıldı ve postoperatif PSG 28 hastaya yapılmıs oldu. Postoperatif PSG'de apne-hipopne indeksi (AH ) 5'ten küçük olan bes hastada CPAP titrasyonu yapılmadıgından postoperatif CPAP titrasyonu toplam 23 hastaya uygulandı. Preoperatif ve postoperatif AH 'leri degerlendirildiginde 12 hastada AH 'nde azalma, 16 hastada ise AH 'nde artma görüldü. Postoperatif AH 'nde azalma görülen 12 hastanın 5'inde AH 5'in altına indi. Ancak, preoperatif ve postoperatif AH 'leri arasında istatistiksel olarak anlamlı fark bulunmadı (p= 0,69). Ameliyat sonrası CPAP titrasyonu sonuçlarına bakıldıgında basınçlarda (p= 0,204) ve AH 'lerinde (p=0,148) preoperatif degerlere göre azalma görülmüsse de istatistiksel olarak anlamlı fark bulunmadı. Hastaların postoperatif dönemdeki anket degerlendirilmesinde horlama sıklıgında (p<0,001) ve burun tıkanıklıgında (p<0,001), GAS'da horlama, apne ve gündüz uyuklama sikâyetlerinde preoperatif dönemdekine oranla anlamlı (p<0,001) derecede azalma tespit edildi. Burun cerrahisi sonrasında elde edilen objektif verilerde (PSG ve CPAP titrasyonu) anlamlı degisiklik saptanmadı. Buna karsın subjektif verilerde (GAS skoru ve horlama semptomlarında ve iyilik halinde) anlamlı düzelme gözlendi. Sonuç olarak, TUAS'lı hastalarda burun patolojileri tedavi edilmelidir. Ancak bu hastalıkların multifaktöriyel ve çok seviyeli oldukları unutulmamalıdır. Bu nedenle her hastada burun cerrahisi sonrası iyi sonuç alınamayabilecegi hastalara açıklanmalıdır.
The aim of this study was to investigate the effect of surgical intervention for nasal pathologies on obstructive sleep apnea syndrome (OSAS) and Continuous Positive Airway Pressure (CPAP) titrations in patients with OSAS by using Polysomnography (PSG). Thirty-four patients who were diagnosed with OSAS between December 2007 and June 2010 and confirmed to have obstructive nasal pathology were invited to the study. Three patients who refused corrective nasal surgery or had systemic problems that interfere with the surgery were excluded from the study. Thirty-one patients who were recruited for the study, were evaluated with epworth sleepiness scale (ESS), OSAS and snoring visual analog scale (VAS). After CPAP titration was performed, surgery for nasal pathology (septal surgery n=25, turbinate surgery n=26, sinus surgery, polipectomy n=4, septorhinoplasty n=2) was implemented. Patients were reevaluated with snore visual analog scale, polysomnography (PSG) and CPAP titration three months after surgical treatment. Thereby, effects of nasal pathologies on OSAS were researched both subjectively and objectively. As three patients refused to undergo control PSG, postoperative PSG evaluation was performed in 28 patients. CPAP titration was not performed in 5 patients whose apnea hypopnea index (AHI) were under 5 in postoperative PSG, therefore, results of postoperative CPAP titration were obtained in 23 patients. When preoperative and postoperative AHI rates were compared, it was observed that lower postoperative AHI results were encountered in 12 patients, whereas, AHI's were higher than the preoperative level in 16 patients. Five out of 12 patients with reduced AHI results, AHI fell under five. However, the difference between preoperative and postoperative AHI's was not statistically significant (p = 0,69). According to the postoperative CPAP titration results, although there was a decrease in pressures (p = 0,204) and AHI's (p= 0,148) with respect to preoperative values, no statistically significant difference has been found. A significant decrease was encountered in snoring frequency and nasal obstruction in patients' postoperative survey analysis and in snoring, apnea and daytime sleepiness complaints in VAS. There was no significant difference at the objective data obtained (by using PSG and CPAP titration) after nasal surgery. But significant improvement at the subjective data by using VAS scores and snoring symptoms and well-being is observed. In conclusion, nasal pathologies should be treated in patients with OSAS. However, it should not be forgotten that these diseases are multifactorial and multi-leveled. Therefore the patients should be informed that favorable result could not be achieved in all patients after nasal surgery.
The aim of this study was to investigate the effect of surgical intervention for nasal pathologies on obstructive sleep apnea syndrome (OSAS) and Continuous Positive Airway Pressure (CPAP) titrations in patients with OSAS by using Polysomnography (PSG). Thirty-four patients who were diagnosed with OSAS between December 2007 and June 2010 and confirmed to have obstructive nasal pathology were invited to the study. Three patients who refused corrective nasal surgery or had systemic problems that interfere with the surgery were excluded from the study. Thirty-one patients who were recruited for the study, were evaluated with epworth sleepiness scale (ESS), OSAS and snoring visual analog scale (VAS). After CPAP titration was performed, surgery for nasal pathology (septal surgery n=25, turbinate surgery n=26, sinus surgery, polipectomy n=4, septorhinoplasty n=2) was implemented. Patients were reevaluated with snore visual analog scale, polysomnography (PSG) and CPAP titration three months after surgical treatment. Thereby, effects of nasal pathologies on OSAS were researched both subjectively and objectively. As three patients refused to undergo control PSG, postoperative PSG evaluation was performed in 28 patients. CPAP titration was not performed in 5 patients whose apnea hypopnea index (AHI) were under 5 in postoperative PSG, therefore, results of postoperative CPAP titration were obtained in 23 patients. When preoperative and postoperative AHI rates were compared, it was observed that lower postoperative AHI results were encountered in 12 patients, whereas, AHI's were higher than the preoperative level in 16 patients. Five out of 12 patients with reduced AHI results, AHI fell under five. However, the difference between preoperative and postoperative AHI's was not statistically significant (p = 0,69). According to the postoperative CPAP titration results, although there was a decrease in pressures (p = 0,204) and AHI's (p= 0,148) with respect to preoperative values, no statistically significant difference has been found. A significant decrease was encountered in snoring frequency and nasal obstruction in patients' postoperative survey analysis and in snoring, apnea and daytime sleepiness complaints in VAS. There was no significant difference at the objective data obtained (by using PSG and CPAP titration) after nasal surgery. But significant improvement at the subjective data by using VAS scores and snoring symptoms and well-being is observed. In conclusion, nasal pathologies should be treated in patients with OSAS. However, it should not be forgotten that these diseases are multifactorial and multi-leveled. Therefore the patients should be informed that favorable result could not be achieved in all patients after nasal surgery.
Description
Keywords
Tıkayıcı uyku apnesi sendromu (TUAS), Nazal cerrahi, Sürekli pozitif havayolu basıncı (CPAP), Polisomnografi (PSG), Obstructive sleep apnea syndrome (OSAS), Nasal surgery, Continuous positive airway pressure (CPAP), Polysomnography (PSG)
Citation
Sufioğlu, M. (2010). Tıkayıcı uyku apnesi sendromunda burun cerrahisinin etkinliği. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.