Effects of Orthognathic Surgery on Posterior Airway Volume and Development of Obstructive Sleep Apnea

Abstract

Objectives: This study aimed to compare preoperative and postoperative polysomnography (PSG) measurements and evaluated the changes in posterior airway space (PAS) volume according to the movements performed in orthognathic surgery. Materials and Methods: The mean age of the 14 patients included in this prospective observational study was 29.57 ± 8.05 years, 9 were female and 5 were male. Patients scheduled to undergo bimaxillary surgery, underwent overnight PSG in the sleep laboratory 1 week before and 3 months after the operation. PSG included the following: Apnea- Hypopnea Index (AHI) (/h), sleep onset (min), sleep efficiency (%), sleep stages (SS) 1 (%) - 2 (%) - 3 (%), rapid eye movement sleep (REM) (%) and oxygen saturation. For all patients, 3D cone beam computed tomography (CBCT) images were acquired 1 week before and 3 months after surgery. The pharyngeal airway was divided into two regions, the nasopharynx (NPV) and oropharynx (OPV). These regions were defined using the posterior nasal spine, posterior part of the ala of vomer and cervical vertebra. Preoperative and postoperative data obtained from CBCT and PSG were compared. Results: In the comparison between AHI changes; the rate of decrease in NPV score was higher in patients with high AHI scores compared to others (p: 0,006). In patients with decreased AHI, the change in REM % was higher than the other groups (p: 0,019). Conclusion: Orthognathic surgery causes changes in posterior airway volume and these changes cause changes in polysomonography data. In this study, it was concluded that NPV decreased more in patients with increased AHI values.

Keywords

• Obstructive sleep apnea
• polysomnography
• orthognathic surgery

Ortognatik Cerrahinin Posterior Hava Yolu Hacmi ve Obstrüktif Uyku Apnesi Gelişimi Üzerine Etkileri

Abstract

Amaç: Bu çalışmada, ortognatik cerrahide uygulanan hareketlere göre posterior hava yolu hacmindeki (PAS) değişikliklerin değerlendirilmesi ve preoperatif ve postoperatif polisomnografi (PSG) ölçümlerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya dahil edilen 14 hastanın yaş ortalaması 29.57 ± 8.05 yıl olup, 9'u kadın ve 5'i erkekti. Bimaksiller cerrahi planlanan hastalara operasyondan 1 hafta önce ve 3 ay sonra uyku laboratuvarında gece boyu PSG uygulanmıştır. PSG’de, Apne-Hipopne İndeksi (AHİ) (/saat), uyku başlangıcı (dk), uyku etkinliği (%), uyku evreleri (SS) 1 (%) - 2 (%) - 3 (%), hızlı göz hareketi uykusu (REM) (%) ve oksijen satürasyonu parametreleri ölçülmüştür. Tüm hastalardan ameliyattan 1 hafta önce ve 3 ay sonra 3D konik ışınlı bilgisayarlı tomografi (CIBT) görüntüleri elde edilmiştir. Faringeal hava yolu nazofarenks (NPV) ve orofarenks (OPV) olmak üzere iki bölgeye ayrılmıştır. Bu bölgeler posterior nazal spine, ala vomerin posterior kısmı ve servikal vertebra kullanılarak tanımlanmıştır. CBCT ve PSG'den elde edilen preoperatif ve postoperatif veriler karşılaştırılmıştır. Bulgular: AHİ değişiklikleri arasındaki karşılaştırmada; AHİ skoru yüksek olan hastalarda NPV skorundaki azalma oranı diğerlerine göre daha yüksekti (p: 0,006). AHİ'si düşük olan hastalarda REM % değişim oranı diğer gruplara göre daha yüksekti (p: 0,019). Sonuç: Ortognatik cerrahi posterior hava yolu hacminde ve polisomonografi verilerinde değişikliklere neden olmaktadır. Bu çalışmada AHİ değerleri yüksek olan hastalarda NPV'nin daha fazla azaldığı sonucuna varılmıştır.

Keywords

• Obstrüktif uyku apnesi
• polisomnografi
• ortognatik cerrahi

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