喉頭周辺疾患による呼吸障害に対する手術治療

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Obstructive Sleep Apnea Syndrome (OSAS) is the condition of complete (Apnea) or partial (hypopnea) airway collapse during sleep. The cardinal daytime symptoms are excessive daytime sleepiness and non- rejuvenating sleep due to recurrent arousals and interrupted sleep caused by intermittent hypoxia and hypercapnia. OSAS is sometimes associated with serious cardiovascular complications, hypertension, stroke and abnormal glucose metabolism. The primary location of airway collapse is in the pharyngeal area, involving the tonsils, soft palate, and tongue base; all of which lay within the ENT specialty. The larynx is not usually a common site for collapse during sleep because of its rigid cartilaginous framework. In our department, the site of collapse is usually investigated through endoscopic examination during drug induced sleep. In the course of endoscopic examinations, a transient collapse in the laryngeal supraglottic structures is sometimes noticed. Nasal continuous positive airway pressure (CPAP) is considered the gold standard therapy for OSAS. For various reasons surgery is recommended as the primary treatment for patients experiencing OSAS due to the collapse of laryngeal supraglottic structures. Patients with mild to moderate OSAS and a corresponding AHI (apnea hypopnea index) less than 20 are restricted by the Japanese insurance system to be treated with CPAP. Another reason is the possibility of serious airway obstruction in that region if an infection and superimposed edema were to occur. In this paper we discuss the surgical procedure which is done in our department for patients with OSAS when the main site of obstruction is in the larynx or in laryngeal surrounding tissues.
2010-12-01

喉頭周辺疾患による呼吸障害に対する手術治療

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