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Ann Maxillofac Surg. 2019 Jan-Jun;9(1):28-36. doi: 10.4103/ams.ams_151_18.

Sleepiness Score-Specific Outcomes of a Novel Tongue Repositioning Procedure for the Treatment of Continuous Positive Airway Pressure-Resistant Obstructive Sleep Apnea.

Author information

1
Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.
2
Department of Medicine, Stellenbosch Mediclinic, Stellenbosch, South Africa.
3
Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Africa.
4
Department of Medicine, Cape Town Mediclinic, Cape Town, South Africa.
5
Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.

Abstract

Background:

The gold standard of treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, more than a third of patients have such difficulty with its chronic use such that they seek other options or choose to remain untreated. We evaluated sleepiness score-specific outcomes and the use of CPAP after tongue repositioning surgery for the treatment of OSA.

Patients and Methods:

A self-administered questionnaire was completed pre- and postoperatively by 10 patients who underwent tongue repositioning surgery for the treatment of OSA from October 2010 to December 2012. The questionnaire included the Epworth Sleepiness Scale (ESS) for the assessment of daytime somnolence and questions regarding CPAP use and overall satisfaction.

Results:

Preoperatively, 6 patients were "very sleepy" (ESS ≥16), 4 patients were "sleepy" (ESS = 10-16), and 0 patients were "not sleepy" (ESS ≤10). 30 days postoperatively, sleepiness scores decreased (10 patients were "not sleepy" (ESS ≤10) with 0 patients "very sleepy" or "sleepy;" P = 0.002). Thus, the median ESS score for the "very sleepy" and "sleepy," decreased from 20 to 4 and 13 to 5, respectively, and the "nonsleepy" group increased from 0 to 4. After a 180-day review, the improved ESS scores remained unchanged (the median for "very sleepy" decreased to 3.5 that for "sleepy" remained at 5, and the median for "not sleepy" decreased to 3.5). Surgery decreased CPAP use by 100%. The surgery was judged to be worthwhile by all 10 of patients using a questionnaire, and all 10 patients said that they would recommend the treatment to other patients with OSA.

Conclusions:

These preliminary data indicate that tongue-repositioning surgery for the treatment of OSA may be effective in improving excessive daytime sleepiness. These proof-of-concept data require confirmation in an appropriately powered controlled study.

KEYWORDS:

Genioplasty; score-specific outcomes; sleep apnea; tongue base surgery

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