OBJECTIVETo investigate the therapeutic effects of multiple level surgery in treating obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODSOne hundred ninety two patients with OSAHS diagnosed by polysomnography were treated through uvulopalatopharyngoplasty (UPPP). Thirty patients were combined with sub-mucous resection of the nasal septum. Forty four patients received sub-mucous resection of the nasal septum and partial inferior turbinectomy. Two patients received sub-mucous resection of the nasal septum and partial resection of the tongue base. Two patients received genioglossus advancement and partial resection of the tongue base. Three patients received partial resection of the tongue base. In addition, the patients with the nasal disease and/or the lingual fat, AHI > 40 times/h, LSaO(2) < 0.64 and/or BMI > 30 kg/m(2) received tracheotomy before general anaesthesia.

RESULTSOne hundred ninety two patients were treated through UPPP. One hundred ninety one patients were successful, one patient died of pneumothorax and cardiac arrest during the incision of the trachea. All patients were followed-up for 6-37 months, among them, 132 patients showed therapeutic effect, with the effective rate as 68.7%. Fifty five patients were cured (AHI < 5 times/h); 39 patients had significant effect (AHI < 20 times/h and decreased > or = 50%); 38 patients were effective (AHI decreased > or = 50%). However, 60 patients did not have any therapeutic effect, with the ineffective rate as 31.3%. Fifty four patients had palatopharyngeal and nasal cavity emphasis, 24 patients had palatopharyngeal and oropharyngeal emphasis, 96 patients had palatopharyngeal and nasal cavity and oropharyngeal emphasis. Some patients were treated with UPPP, which made effective rate as 15 (68.2%), 12 (63.2%), 29 (55.8%). The others were treated with multiple level operations, which made effective rate as 25 (78.1%), 5 (5/5), 33 (75.0%). The effective rate was 60.2% (56/93) by simple UPPP and it was 77.8% (63/81) by multiple level treatment in patients with multiple level obstruction. There was statistical significance between them (chi(2) = 6.2, P = 0.01).

CONCLUSIONSThe effective rate was improved through multiple level operations in OSAHS patients. The serious complications could be prevented through tracheotomy before general anaesthesia in patients with severe OSAHS who needed multiple level surgery.