The Efficacy and Maintain Effect of OPR on OSA Patients After Palatal Surgery

Background: The pathophysiology of obstructive sleep apnea (OSA) includes anatomical and non-anatomical factors. The patients who are suitable for sleep surgery may have the non-anatomical factors at the same time. Oropharyngeal rehabilitation (OPR) for the extrinsic and intrinsic muscles of the tongue might mitigate sleep apnea by preventing airway collapse and reducing the volume of the tongue base. In addition, previous studies also suggested that increasing the tension of the tongue extrinsic/intrinsic muscles may decrease the collapsibility of the upper airway and further prevent airway collapse during sleep. Although palatal surgery and OPR both can improve the severity of OSA, there is lack of literatures about the maintain effect of palatal surgery combined OPR. The aim of this study is to evaluate the maintain effect by using the severity of OSA, tongue muscle strength and the space of the upper airway. Our team have developed force sensing resistor to record the times and frequency of OPR at home from 2022. However, the investigators have to use SD card to record data in the present version. The investigators will optimize the force sensing resistor to upload data to Google Drive by using wifi. In this way, the investigators will know the daily training situation and give feedback to participants immediately by using LINE.

Methods：Seventy-five adult OSA patients will be recruited for this study. Participants will be divided into 3 groups including palatal surgery combined OPR group, palatal surgery group and OPR group by the doctor's advice and their willingness. In the palatal surgery combined OPR group, the participants will receive the palatal surgery and 3-month OPR. In the palatal surgery group and OPR group, the participants will receive palatal surgery or 3-month OPR, respectively. The OPR for the treatment groups included three 30-minute sessions of OPR per day, and the exercise would be performed 3-5 days per week for 3 months. The performance of the home exercise will also be recorded by the force-sensing resistor. In addition to home exercise sessions, there will also be twice-weekly clinical visits to adjust the contents of OPR program and monitor training progress. To evaluate the effect of treatments on the severity of OSA, tongue muscle strength and the space of the upper airway, the participants will receive polysomonogrphy test, tongue muscle strength test and computed tomography. The time of evaluation will include baseline, 3 and 6 months after treatment.

Expected outcomes：

1. The severity of OSA, tongue muscle strength and the space of upper airway will improve more in the palatal surgery combined OPR group than the other two groups. 2. The maintain effect of tongue muscle strength and the space of upper airway is better in the palatal surgery combined OPR group.

• Electroencephalography from Polysomnography (PSG) [Time frame: Single night (8 hours)]
• Electrooculography from Polysomnography (PSG) [Time frame: Single night (8 hours)]
• Electromyography from Polysomnography (PSG) [Time frame: Single night (8 hours)]
• Thoracic and abdominal respiratory inductance plethysmography from Polysomnography (PSG) [Time frame: Single night (8 hours)]
• Body position sensor-modified lead II electrocardiography from Polysomnography (PSG) [Time frame: Single night (8 hours)]
• Nasal cannula pressure transducer from PSG [Time frame: Single night (8 hours)]
• Oronasal thermistor from PSG [Time frame: Single night (8 hours)]
• Finger pulse oximetry from PSG [Time frame: Single night (8 hours)]
• Pharyngeal airway volume [Time frame: 10-20 minutes]
• Minimal cross-sectional areas [Time frame: 10-20 minutes]
• Minimal distance between the lateral pharyngeal wall on both sides, and minimal distance between the anterior and posterior pharyngeal wall [Time frame: 10-20 minutes]
• Epworth Sleepiness Scale (ESS) [Time frame: 5 minutes]