EVALUATION OF PATIENTS WITH SLEEP-APNEA AFTER TRACHEOTOMY

Objective: To determine the effect of tracheotomy on polysomnographic and arterial blood gas data in patients with obstructive sleep apnea ( OSA). Design: A retrospective study of all patients who underwent trac heotomy and were studied polysomnographically at the Johns Hopkins Sle ep Disorders Center, Baltimore, Md, since 1981. Setting: A regional sl eep disorders center. Patients: Twenty-eight patients (8 women and 20 men), aged 22 through 77 years. Patients were categorized into 2 group s on the basis of whether they had already undergone tracheotomy befor e polysomnography. Group 1 patients all had a polysomnographic diagnos is of OSA before tracheotomy. They were further subdivided on the basi s of whether cardiopulmonary decompensation had been absent (group 1a, n = 10) or present (group 1b, n = 13). Group 2 patients (n = 5) had u ndergone tracheotomy to treat upper airway obstruction that developed after non-apnea-related upper aerodigestive tract surgeries. Intervent ion: Tracheotomy. Main Outcome Measures: Nocturnal non-rapid eye movem ent, apnea-hypopnea index, percentage oxyhemoglobin saturation, and ar terial blood gas data. Results: Patients with OSA underwent tracheotom y as definitive treatment for the apnea (n = 15), to prevent postopera tive upper airway compromise after uvulopalatopharyngoplasty (n = 7), and to treat upper airway compromise after non-apnea-related upper aer odigestive tract surgeries (n = 6). Tracheotomy alleviated apnea in al l 10 patients with uncomplicated sleep apnea (group 1a). For patients with OSA complicated by cardiopulmonary decompensation (group 1b), tra cheotomy improved but did not eliminate sleep apnea in 7 of the 13 pat ients, despite overall improvement in arterial blood gas values. For p atients whose sleep apnea had not been diagnosed polysomnographically before tracheotomy (group 2), tracheotomy was still required to treat OSA that had previously not been recognized. Conclusions: Tracheotomy effectively treated patients with uncomplicated OSA, but was much less effective in treating patients with OSA and cardiopulmonary decompens ation. In patients who underwent tracheotomy in conjunction with other upper aerodigestive tract surgeries, concomitant obstructive sleep ap nea often required continued use of a tracheotomy to maintain upper ai rway patency.