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Plasma Radiofrequency Preceded by Pressure Recording Enhances Success for Treating Sleep‐Related Breathing Disorders
Author(s) -
Tvinnereim Magne,
Mitic Svetislav,
Hansen Rolf K.
Publication year - 2007
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/mlg.0b013e31803250f0
Subject(s) - medicine , interquartile range , uvulopalatopharyngoplasty , epworth sleepiness scale , visual analogue scale , hypopnea , apnea–hypopnea index , anesthesia , apnea , obstructive sleep apnea , breathing , airway obstruction , sleep apnea , airway , surgery , polysomnography
Objectives : Sleep‐related breathing disorders (SRBD) that cannot be treated conservatively are commonly treated using uvulopalatopharyngoplasty, although success rates are generally less than 70%. The purpose of this study was to assess a plasma‐mediated radiofrequency (RF)‐based coblation assisted upper airway procedure (CAUP) to treat SRBD patients determined to have obstruction localized to the upper (mid)‐pharyngeal region. Study Design : Prospective case series (n = 40). Methods : Six patients had socially bothersome snoring, and 34 patients had mild to moderate sleep apnea (apnea/hypopnea index [AHI] <20), with the primary level of obstruction (>50%) within the upper pharyngeal region as determined using whole night recordings, including airway pressure fluctuation monitoring (ApneaGraph, MRA‐Medical Ltd, Gloucestershire, UK). CAUP consisted of making a lateral palatal incision, ablating three upward channels on each side of the midline (fan‐shaped) into the soft palate using a plasma mediated RF‐based device (ArthroCare Corporation, Austin, TX), and performing a partial uvulectomy. Clinical outcomes included the Epworth Sleepiness Scale (ESS), partner rating of snoring using a visual analogue scale (VAS), and night‐time apnea and hypopnea events (AHI, hypopnea index [HI], apnea index [AI]). Results : Patients were 28 to 68 (46 ± 12) years old; 28 (70%) were male. Preoperatively, clinical assessment scores (median ± interquartile range) were as follows: ESS (11.0 ± 3.0), VAS (8.15 ± 1.00), AHI (9.58 ± 5.58), HI (9.00 ± 5.29), AI (0.333 ± 0.625). After CAUP, no postoperative scarring, fibrosis, or any other clinically significant side effects were observed. Postoperatively (9.1 ± 1.5; 7–15 mo), ESS (4.0 ± 1.0), VAS (2.70 ± 1.38), AHI (3.75 ± 2.92), HI (3.58 ± 2.50), and AI (0.167 ± 0.167) were significantly improved ( P < .001). Conclusion : CAUP preceded by site‐specific obstruction diagnosis using pressure recording is a well‐tolerated outpatient treatment that is well suited for treating SRBD.