ORIGINAL ARTICLE   

Otorinolaringologia 2018 June;68(2):51-7

DOI: 10.23736/S0392-6621.17.02140-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Multidisciplinary management of obstructive sleep apnea syndrome

Carmine F. GERVASIO ¹, Giovanni GERBINO ², Giuseppe RIVA ¹ ✉, Eleonora SCHELLINO ², Alessandro CICOLIN ³, Federico CARANZANO ¹, Francesca FRIGIOLINI ¹, Pamela GIORDANO ¹, Simona DEFILIPPI ¹, Elena PIUMETTO ⁴, Giancarlo PECORARI ¹, Roberto ALBERA ¹

¹ Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy; ² Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy; ³ Sleep Disorder Center, Department of Neurosciences, University of Turin, Turin, Italy; ⁴ Division of Otorhinolaryngology, Sant’Annunziata Hospital, Savigliano, Cuneo, Italy

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a common disorder. Despite innovation in diagnostic tools and therapeutic options, a significant proportion of failures still remains. The aim of this retrospective study was to evaluate the clinical characteristics of the patients who underwent a multidisciplinary board evaluation at our Division. Moreover, we analyzed the impact of this approach to OSAS on the success rate of surgical procedures and oral appliances.
METHODS: Between June 2010 and May 2015, 893 patients with OSAS were evaluated at our Department. All the patients underwent a complete physical examination and fiberoptic pharyngolaryngoscopy with Müller test. Drug-induced sleep endoscopy (DISE) was suggested for patients who refused or failed continuous positive airway pressure (CPAP) therapy. Then, the patients underwent an evaluation by a multidisciplinary board to identify the best treatment. Surgical procedures and mandibular advancement devices (MAD) were the main options proposed to the patients.
RESULTS: DISE was performed in 133 cases and 119 of them (89.5%) were evaluated by the multidisciplinary team, consisting of a neurologist, an otolaryngologist, a maxillofacial surgeon and a orthodontist. Success rate was 74.2% for otorhinolaryngological procedures, 91.7% for maxillofacial procedures, and 66.7% for combined ones. Thus, success rate for surgical treatment was 78.3%, while oral appliances had a 93.3% of success. The global success rate was 82.0%.
CONCLUSIONS: DISE and multidisciplinary board evaluation allow to achieve a patient-tailored treatment with an high success rate. They should be introduced in routine daily practice for patients with OSAS who failed or refused ventilatory therapy.

KEY WORDS: Sleep apnea, obstructive - Endoscopy - Surgery