The Effects of Expansion Sphincter Pharyngoplasty on the Apnea Hypopnea Index and Heart Rate Variability

Publication date: Available online 10 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ahmet Emre Süslü, Gözde Pamuk, Ahmet Erim Pamuk, Serdar Özer, Shamkhal Jafarov, T.Metin Önerci
PurposeHeart rate variability (HRV) is a non-invasive and sensitive method used to evaluate autonomic function of the heart based on specific polysomnographic parameters. This study aimed to determine the effect of expansion sphincter pharyngoplasty (ESP) on HRV and the apnea hypopnea index (AHI) in patients with obstructive sleep apnea (OSA).Materials and MethodsThis retrospective cohort study included patients that presented to Hacettepe University Hospital, Department of Otorhinolaryngology, were diagnosed as OSA, and underwent ESP. Patient medical records, including demographic data, polysomnography findings, and HRV parameters were reviewed. The predictor variable was the effect of ESP on the AHI and the primary outcome variables were HRV parameters. Descriptive and bivariate statistics were computed using the chi-square test, t-test, and Mann-Whitney U test.ResultsMean age of the 28 patients (20 male and 8 female) was 43 ± 9.9 years. Surgical success (AHI <20 and a 50% decrease in the AHI) was achieved in 16 (57.1%) patients. The AHI decreased in 22 (78.6%) patients, versus increased in 6 (21.4%) patients following ESP. The LF/HF ratio decreased significantly in the successful surgery patients and in those in which the AHI decreased postsurgery (P = 0.02 and P = 0.001, respectively). With respect to change in the LF/HF ratio, 19 patients had a decrease in sympathetic activity, whereas 9 had an increase in sympathetic activity following ESP. A decrease in sympathetic activity post ESP was significantly associated with surgical success and a decrease in the AHI (P = 0.033 and P = 0.001, respectively).ConclusionESP is an effective surgical option for the treatment of OSA and lowers the AHI. Successful ESP plays a role in decreasing sympathetic activity of the heart, which might be associated with a reduction in the risk of cardiovascular disease.



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