OBSTRUCTIVE SLEEP-APNEA AND THE HYOID - A REVISED SURGICAL-PROCEDURE

Obstructive sleep apnea syndrome results from a loss of muscular activ ity of pharyngeal dilators and airway collapse at the hypopharynx-base of tongue or the oropharynx-soft palate. The hyoid arch and its muscl e attachments strongly affect hypopharyngeal airway patency and resist ance. On the basis of these concepts and previous experience, a modifi ed hyoid suspension procedure is presented. Fifteen consecutively trea ted surgical patients underwent an isolated modified hyoid suspension procedure to correct hypopharyngeal obstruction. Oropharyngeal-palatal obstruction had previously been corrected or was thought not to be a component of the obstruction. Treatment outcomes were based on objecti ve polysomnographic data and subjective clinical correction of excessi ve daytime sleepiness. The polysomnographic data included analysis of the respiratory disturbance index and lowest oxyhemoglobin desaturatio n. On the basis of these criteria, 12 of 15 patients (75%) had correct ion of their excessive daytime sleepiness and marked improvement in th eir sleep disorder breathing. The mean preoperative respiratory distur bance index was 44.7 +/- 22.6, and the lowest oxyhemoglobin desaturati on was 82% +/- 6%. The postoperative respiratory disturbance index and lowest oxyhemoglobin desaturation were 12.8 +/- 6.9 and 86% +/- 5%, r espectively. The modified hyoid suspension procedure appears to offer significant adjunctive treatment for hypopharyngeal obstruction in obs tructive sleep apnea syndrome.