Z-palatopharyngoplasty for obstructive sleep apnea/hypopnea syndrome

Abstract

Objective: To explore the feasibility, outcomes, and factors affecting the outcome of Z-palatopharyngoplasty (ZP3) in the treatment of severe obstructive sleep apnea/hypopnea syndrome (OSAHS). Study Design: Case series with chart review. Methods: ZP3 was performed on 34 Friedman stage II/III OSAHS patients with a posterior airway space (PAS) ≥ 11 mm. Postoperative follow-up was at least 6 months, and the differences between responders and nonresponders were analyzed. Results: On the basis of success criteria, defined as an apnea-hypopnea index < 20 and a decrease > 50 percent, the success rate was 64.7 percent. The lowest oxygen saturation (LSaO2), percentage of time with an oxyhemoglobin saturation below 90 percent (CT90), mandibular plane angle (MPA), mandibular body length, position of the tongue, and Friedman clinical stage differed significantly between responders and nonresponders. The logistic regression analysis showed that MPA and Friedman stage were the key predictors of ZP3 surgical success. The best cutoff points for LSaO2, CT90, and MPA were 72 percent, 22.80 percent, and 29.40°, respectively. Conclusions: Factors affecting the outcome of ZP3 included LSaO2, CT90, MPA, mandibular body length, position of the tongue, and Friedman clinical stage. Of these, the MPA and Friedman clinical stage were most influential.