2020, Number 2
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Acta de Otorrinolaringología CCC 2020; 48 (2)
Polisomnographic results of adult patients with bilateral vocal cord paralysis and diagnosis of hypopnea sleep apnea syndrome managed with posterior cordectomy: study before-after
Solano RCA, Delgado SLC, Hernández AVJ, Camilo PJ
Language: Spanish
References: 32
Page: 154-164
PDF size: 230.82 Kb.
ABSTRACT
Background: bilateral vocal cord paralysis (BVFP) and obstructive sleep apnea-hypopnea
syndrome (OSAHS) are pathologies that generate respiratory limitation. As
they are obstructive airway diseases, it is reasonable to consider a possible relationship.
Materials and methods: a before and after study was performed, in two university
centers in Bogotá, frequencies and measures of central tendency were described. The
McNemar BoWker and paired T or Wilcoxon tests were used, considering p ‹0.05
significant.
Results: 14 patients were managed with transverse posterior cordectomy.
100 % were female and the mean age of 51.2±10.73 years. The average BMI was
25.42±5.4, 50 % had normal BMI. OSAHS severity was mild 42.9 %, moderate 28.6
% and severe 28.6 % disease classification. The intervention was successful in 64.28
%, there was a 54 % reduction in presurgical Apnea Hypopnea Index compared to
the post-surgical one (p = 0.029), 85.6 % reduction in the index of obstructive apneas
(p = 0.017), in the index of hypopneas in 52 % (p = 0.028) and sleep latency
in 33.3 % (p = 0.025). Other variables showed no significant differences (p ›0.05).
Conclusions: the results described show a statistically significant relationship between
OSAHS and BVFP. Patients with BVFP benefited from the use of posterior
cordectomy as a therapeutic intervention reducing the severity rates of OSAHS and
thus improving the quality of life of patients.
REFERENCES
Rosenthal LH, Benninger MS, Deeb RH. Vocal foldimmobility: a longitudinal analysis of etiology over 20years. Laryngoscope. 2007;117(10):1864-1870. https://doi.org/10.1097/MLG.0b013e3180de4d49
Muñoz-Tamayo JF, Hernández-Alarcón VJ, Morales-Rubio LJ.Funcionalidad de la vía aérea de los pacientes con inmovilidadbilateral de cuerdas vocales sometidos a cordectomía posteriorentre los años 2010-2015. Acta otorrinolaringol. cir. cabezacuello. 2016;44(1):33-8. https://doi.org/10.37076/acorl.v44i1.41
Young VN, Rosen CA. Arytenoid and posterior vocal foldsurgery for bilateral vocal fold immobility. Curr OpinOtolaryngol Head Neck Surg. 2011;19(6):422-427. https://doi.org/10.1097/MOO.0b013e32834c1f1c
Pinto JA, Godoy LB, Marquis VW, Sonego TB, Leal Cde F.Bilateral vocal fold immobility: diagnosis and treatment.Braz J Otorhinolaryngol. 2011;77(5):594-599. https://doi.org/10.1590/s1808-86942011000500010
Rubin AD, Sataloff RT. Vocal fold paresis and paralysis.Otolaryngol Clin North Am. 2007;40(5):1109-ix. https://doi.org/10.1016/j.otc.2007.05.012
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A,Patil SP, et al. Clinical guideline for the evaluation, managementand long-term care of obstructive sleep apnea in adults. J ClinSleep Med. 2009 Jun 15;5(3):263-76.
Jordan AS, McSharry DG, Malhotra A. Adult obstructivesleep apnoea. Lancet. 2014;383(9918):736-47. https://doi.org/10.1016/S0140-6736(13)60734-5
Sateia MJ. International classification of sleep disorders-thirdedition: highlights and modifications. Chest. 2014;146(5):1387-1394. https://doi.org/10.1378/chest.14-0970
Woodson BT, Franco R. Physiology of sleep disorderedbreathing. Otolaryngol Clin North Am. 2007;40(4):691-711.https://doi.org/10.1016/j.otc.2007.04.002
Amado S, Gómez J, Avellaneda J, Quijano D. Guía para el diagnósticoy tratamiento del síndrome de apnea hipopnea obstructiva del sueño.En: Guías ACORL para el manejo de las patologías más frecuentesen otorrinolaringología; 2016. p. 149–65.
Scottish Intercollegiate Guidelines Network. Management ofObstructive Sleep Apnoea/Hypopnoea Syndrome in Adults - Anational clinical guideline. Royal College of Physicians, editor.Edinburgh; 2003. p. 1-36.
Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA,Khayat R, Javaheri S, et al. Sleep Apnea: Types, Mechanisms,and Clinical Cardiovascular Consequences. J Am Coll Cardiol.2017 Feb 21;69(7):841–58. Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. SleepApnea: Types, Mechanisms, and Clinical CardiovascularConsequences. J Am Coll Cardiol. 2017 Feb 21;69(7):841-858.https://doi.org/10.1016/j.jacc.2016.11.069
Strohl KP, Brown DB, Collop N, George C, Grunstein R,Han F, et al. An official American Thoracic Society ClinicalPractice Guideline: sleep apnea, sleepiness, and driving risk innoncommercial drivers. An update of a 1994 Statement. Am JRespir Crit Care Med. 2013 Jun 1;187(11):1259-66. https://doi.org/10.1164/rccm.201304-0726ST
Camacho M, Jacobson RL, Schendel SA. Surgical Treatment ofObstructive Sleep Apnea. Sleep Med Clin . 2013;8(4):495-503.
Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB,Katz SG, et al. Surgical modifications of the upper airway forobstructive sleep apnea in adults: a systematic review and metaanalysis.Sleep. 2010;33(10):1396-407. https://doi.org/10.1093/sleep/33.10.1396
Cho GS, Chung Y-S. A Case of Nocturnal Stridor withCombined Obstructive Sleep Apnea Caused by Bilateral VocalCord Palsy. Sleep Med Res. 2011;2(2):69–71.
Aziz L, Ejnell H. Obstructive sleep apnea caused by bilateralvocal fold paralysis. Ear, Nose Throat J. 2003;82(4):326–7.
Misiolek M, Namyslowski G, Czecior E, Scierski W, KarpeJ, Misiolek H, et al. Obstructive sleep apnea syndrome andsnoring in patients with bilateral vocal cord paralysis. EurArch Oto-Rhino-Laryngology. 2003;260(4):183–5. https://doi.org/10.1007/s00405-002-0545-z
Dedhia RC, Rosen CA, Soose RJ. What is the role of thelarynx in adult obstructive sleep apnea? Laryngoscope.
2014;124(4):1029–34. https://doi.org/10.1002/lary.2449420. Li H-Y, Wang P-C, Hsu C-Y, Chen N-H, Fang T-J. Changes ofsleep-disordered breathing after laryngeal surgery in patients withbilateral vocal fold paralysis. Eur Arch Otorhinolaryngol . 2005Apr;262(4):294–7. https://doi.org/10.1007/s00405-004-0820-2
Sariman N, Koca Ö, Boyaci Z, Levent E, Soylu AC, AlparslanS, et al. Microscopic bilateral posterior cordotomy in severeobstructive sleep apnea syndrome with bilateral vocal cordparalysis. Sleep Breath. 2012;16(1):17–22. https://doi.org/10.1007/s11325-010-0458-9
Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, PlodkowskiRA. Diagnosis and treatment of patients with thyroid cancer.Am Health Drug Benefits. 2015;8(1):3040.
Bosley B, Rosen C, Simpson C, McMullin B, Gartner-Schmidt J. Medial arytenoidectomy versus transversecordotomy as a treatment for bilateral vocal fold paralysis.Ann Otol Rhinol Laryngol. 2005;114(12):922–6. https://doi.org/10.1177/000348940511401205
Pang KP, Rotenberg BW. The SLEEP GOAL as a successcriteria in obstructive sleep apnea therapy. Eur Arch Oto-Rhino-Laryngology. 2016 May 22;273(5):1063–5. https://doi.org/10.1007/s00405-016-3944-2
Venugopal M, Rajasekar, M Narendrakumar V, Sivaranjani M. Astudy on evaluation of pre and postoperative polysomnographyfor obstructive sleep apnea patients. Int J OtorhinolaryngolHead Neck Srug. 2017;1–7.
Kezirian EJ, Goldberg AN. Hypopharyngeal Surgery inObstructive Sleep Apnea. Arch Otolaryngol Neck Surg.2006;132(2):206-13. https://doi.org/10.1001/archotol.132.2.206
Bajaj Y, Sethi N, Shayah A, Harris AT, Henshaw P, CoatesworthAP, et al. Vocal fold paralysis: Role of bilateral transversecordotomy. J Laryngol Otol. 2009;123(12):1348–51. https://doi.org/10.1017/S0022215109990983
Szmeja Z, Wójtowicz JG. Laser arytenoidectomy in thetreatment of bilateral vocal cord paralysis. Eur ArchOtorhinolaryngol. 1999;256(8):388–9. https://doi.org/10.1007/s004050050170
Sapundzhiev N, Lichtenberger G, Eckel HE, Friedrich G, ZenevI, Toohill RJ, et al. Surgery of adult bilateral vocal fold paralysisin adduction: history and trends. Eur Arch Otorhinolaryngol.2008;265(12):1501–14. https://doi.org/10.1007/s00405-008-0665-1
Khan A, Ramar K, Maddirala S, Friedman O, Pallanch JF,Olson EJ. Uvulopalatopharyngoplasty in the management ofobstructive sleep apnea: the mayo clinic experience. MayoClin Proc. 2009;84(9):795–800. https://doi.org/10.1016/S0025-6196(11)60489-8
Elshaug AG, Moss JR, Southcott AM, Hiller JE. Redefiningsuccess in airway surgery for obstructive sleep apnea: a metaanalysis and synthesis of the evidence. Sleep. 2007;30(4):461–7. https://doi.org/10.1093/sleep/30.4.461
Senaratna C V, Perret JL, Lodge CJ, Lowe AJ, Campbell BE,Matheson MC, et al. Prevalence of obstructive sleep apnea inthe general population: A systematic review. Sleep Med Rev.2017;34:70–81. https://doi.org/10.1016/j.smrv.2016.07.002