Chest ACCP Education Calendar
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (2)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Saint Raymond, C.
Right arrow Articles by Pépin, J.-L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Saint Raymond, C.
Right arrow Articles by Pépin, J.-L.
(Chest. 2004;125:864-871.)
© 2004 American College of Chest Physicians

Sphincter Pharyngoplasty as a Treatment of Velopharyngeal Incompetence in Young People*

A Prospective Evaluation of Effects on Sleep Structure and Sleep Respiratory Disturbances

Christel Saint Raymond, MD; Georges Bettega, MD, PhD; Christel Deschaux, MSc; Jacques Lebeau, MD; Bernard Raphael, MD; Patrick Lévy, MD, PhD and Jean-Louis Pépin, MD, PhD

* From the Department of Respiratory Medicine (Drs. Saint Raymond, Lévy, and Pépin, and Mrs. Deschaux), Intensive Care Unit and Sleep Laboratory, HP2 Laboratory, University Hospital; and Maxillofacial Surgery (Drs. Bettega, Lebeau, and Raphael), University Hospital, Grenoble, France.

Correspondence to: Jean-Louis Pépin, MD, PhD, Département de Médecine Aigue Spécialisée (DMAS), Unité Sommeil et Respiration, CHU de Grenoble, BP 217 X, 38043, Grenoble, France; e-mail: JPepin{at}chu-grenoble.fr

Background: Sphincter pharyngoplasty (SP) appears to be the more "physiologic" surgical technique to treat velopharyngeal incompetence (VPI). This procedure creates a dynamic sphincter of variable diameter and keeps the flexibility of the soft palate. SP also induces velopharyngeal size reduction, mainly in the transverse diameter, which may cause upper airway (UA) occlusions during sleep.

Aim: To prospectively evaluate the effects of SP by a modified Orticochea procedure on sleep structure and sleep respiratory disturbances.

Methods: Polysomnographic studies before and after surgery in 17 consecutive patients treated by a modified Orticochea procedure SP for VPI.

Results: For the whole group, SP did not induce significant impairment of apnea-hypopnea index or nocturnal oxygen saturation. Slow-wave sleep (SWS) was significantly reduced after surgery (25 ± 9% of total sleep time [TST] vs 28 ± 9% of TST before SP [p = 0.04]). Following surgery, there was a trend for an increase in the microarousal index) (p = 0.09) and more specifically in respiratory-related microarousals.

Conclusion: SP, although creating a clinically obvious reduction of velopharyngeal diameter, generally did not lead to the occurrence of an obstructive sleep apnea syndrome. However, we found a significant reduction of SWS quantity and a trend toward an increase in the number of cortical microarousals. These findings suggest that the reduction of UA diameter associated with the surgical technique leads to increases in respiratory effort sufficient to induce sleep fragmentation and SWS reduction, even in the absence of apneas or hypopneas.

Key Words: cleft palate • dynamic sphincter pharyngoplasty • sleep apnea • velopharyngeal insufficiency






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2004 by the American College of Chest Physicians.