EFFIICACY OF RADIIOFREQUENCY ELECTROSURGERY OF THE SOFT PALATE IIN THE TREATMENT OF SNORIING AND OBSTRUCTIIVE SLEEP APNEA

Abstract

Obstructive sleep apnea–hypopnea syndrome is characterized by recurrent episodes of upper airway collapse and obstruction during sleep causing drops in arterial oxygen saturation and arousals from sleep. Clinically obstructive sleep apnea-hypopnea syndrome is associated with snoring, excessive daytime sleepiness, lack of concentration, fatigue, gasping, choking, nocturnal enuresis, night mares and mood changes. Snoring is a low frequency sound produced due to a combination of a narrowed pharyngeal airway and redundant vibratory tissues. The soft palate, including the uvula, has been reported to be the primary vibratory tissue in 70-90% of cases. The prevalence of snoring in over 30-year-old is 44 % in men and 28 % in women, also 9 % of men and 4 % of women had an Apnea Hypopnea Index (AHI) of greater than 15, indicating that a significant proportion of the population have moderate obstructive sleep apnea. Treatment of snoring and obstructive sleep apnea includes conservative measures such as weight loss, position therapy, alcohol and sedative avoidance, and smoking cessation. Active treatment methods include mandibular advancement appliances and continuous positive airway pressure treatment; however, both are associated with poor compliance. Surgical interventions, considered when conservative treatment methods fail aiming , share a common goal, i.e., reduction, stiffening, and stabilization of the soft palate. There are many soft palate surgical interventions, including uvulopalatopharyngoplasty, uvulopalatoplasty, and laser assisted uvulopalatoplasty. The interventions are associated with considerable short and long term morbidity and lack of evidence-based proof of effectiveness. Thus, there is a clear need for a minimally invasive and efficient treatment modality with low morbidity. Radiofrequency (RF) electrosurgery is a type of electrosurgery in which application of radiofrequency energy to the tissue leading to inflammation, coagulative necrosis, and fibrosis of these tissues. Radiofrequency electrosurgery on human soft palate for the treatment of snoring and obstructive sleep apnea was first introduced by Powell NB in 1998 with reported excellent results especially for snoring.