Biomedical subjects
Publications and source records attributed to F Zorick.
Both muscular hypotonia and anatomic abnormalities have been implicated in the pathogenesis of the obstructive sleep apnea syndrome (OSAS). The upper airways of 25 patients with OSAS were evaluated to determine potential sites of obstruction. Significant airway compromise was found in all patients with some patients having multiple sites of airway narrowing.
Excessive daytime sleepiness and loud snoring are the major symptoms of obstructive sleep apnea, often leading to serious medical complications if unrecognized and untreated. Tracheostomy has been the only effective treatment in most adult cases. This paper reports on a new surgical approach to treat obstructive sleep apnea by uvulopalatopharyngoplasty designed to enlarge the potential airspace in the oropharynx. Twelve patients underwent this operation. In nine there was relief of symptoms and in eight there was objective improvement in nocturnal respiration and sleep pattern, demonstrated by polysomnography.
Pre- and post-treatment nocturnal polysomnography and multiple sleep latency tests (MSLT) were done in thirty-one patients with obstructive sleep apnea syndrome who underwent uvulopalatopharyngoplasty. The treatment reduced by half the frequency of apneas and hypoxemia occurring during sleep and improved the excessive daytime sleepiness, but not all patients responded similarly. Among patients classified as responders, the frequency of apnea was reduced to a level seen in healthy adults of the same age, measures of sleep approached normal, and excessive sleepiness was eliminated. In nonresponders, frequency of apneas and consequent disruption of sleep was not reduced, but hypoxemia was improved. The MSLT differentiated responders from nonresponders who showed no MSLT improvement, although 70% reported a subjective improvement in excessive sleepiness. Measures of the apneas' disruptive effect on sleep and not its hypoxemic consequences were most predictive of improvement in excessive sleepiness.