Oropharyngeal Pathology and Results of Surgical Treatment of Patients with Sleep Disturbed Breathing. Summary of the Doctoral Thesis

Abstract

Objectives. Obstructive Sleep Apnoea Syndrome (OSAS) is a common medical and social problem that affects up to 5% of the adult population. OMAS is associated with significant comorbidities. Professional associations of cardiologists, neurologists, endocrinologists in the EU, the USA and other countries regard OSAS as one of the causes of hypertension and increased risk of cardiovascular disease, diabetes mellitus type II, metabolic syndrome and cognitive disorders. The Council of the European Union is preparing the Directive 91/439/EEC, which provides inclusion of severe forms of OSAS into the list of medical conditions disqualifying a person from obtaining a driver’s license. OSAS is also associated with increased perioperative risk. The study was conducted from 2003 through November 2012 at the Institute of Stomatology of RSU and Sleep Laboratory. 97 of all surgically treated patients having complaints regarding snoring and other respiratory disorders during sleep and from whom it was possible to obtain the necessary data were included in the study. Patients from the study group (n=97) underwent sleep tests and a survey (including survey of bed partners). In the result of the examination we determined degrees of breathing disorders, and patients opted for surgical treatment in order to eliminate their medical condition. The mean age of patients was 38.7 years, the total number of males was 86, and females – 11. We additionally performed radiologic imaging of upper airways in order to determine the narrowest sites of airways, and histological examinations of the resected airway soft tissue samples. The most frequently we applied the following surgical treatment techniques: uvulopalatoplasty, tonsilectomy, nasal breathing enhancing surgeries and tongue base reduction with radiofrequency. Sleep tests and questionnaires were repeated after surgical treatment in order to evaluate the outcomes. We found statistically significant link between the size of airways and both the body mass index and the severity of obstructive sleep apnoea. The narrower were airways, the higher were both of the abovementioned values. The narrowest sites were located at the oropharyngeal level, in the area of tongue base. Resected soft tissue samples were investigated at the Institute of Pathology of Pauls Stradins Clinical University Hospital. It was found that the prevailing pathomorphological changes are associated with inflammation and affecting the epithelium layer, submucosal layer, as well as muscle tissue, namely, as the dystrophy and atrophy, which correlates with the severity of OSAS. We compared results of anthropometric, clinical, radiological and laboratory tests of the patients with the outcomes of surgical treatment. We searched for clinical, laboratory, radiological and other prognostic factors affecting surgical treatment results. We analyzed the results of surgical treatment and compared them with other studies. We obtain statistically significant data on impact of some physical and clinical factors on surgical treatment results. Based on the prognostic factors, we developed practical recommendations for selection of patients for surgical treatment. For the conduct of the study the approval of the ethics committee was received (Annex 5).