Very severe obstructive sleep apnea (OSA) with apnea–hypopnea index (AHI) ≥ 60 events/h differs in several areas from OSA with other severities, including having a low-level daytime partial pressure of oxygen and residual on-CPAP (continuous positive airway pressure) AHIs greater than 20/h. Patients with very severe OSA show narrow retroglossal space and confined framework, which is difficult to be enlarged via conventional Uvulopalatopharyngoplasty (UPPP) surgery, resulting in poor response to non-framework surgeries. Our latest report showed efficacy and efficiency for subjects undergoing modified Z-palatoplasty (ZPP) with one-layer closure in a one-stage multilevel surgery. It is unclear whether and how this procedure could help patients with very severe OSA characterized with confined framework. From Mar. 2015 to May 2018, we enrolled 12 patients with very severe OSA receiving one-stage multi-level surgery with modified ZPP with one-layer closure, CO2 laser partial tongue-base glossectomy, and bilateral septomeatoplasty. Our results show that the surgery reduced AHI from 73.8 ± 10.7 to 30.8 ± 23.2 events/h and achieved a mean AHI reduction of 58.3% (p < 0.001 against 0 reduction or no surgery). The surgery shifted components of the breathing disturbances. It reduced more apnea than hypopnea and might convert some apnea to hypopnea.

呼吸暂停低通气指数 (AHI) ≥ 60 次/小时的非常严重的阻塞性睡眠呼吸暂停 (OSA) 在几个方面与其他严重程度的 OSA 不同，包括白天低水平氧分压和持续正压通气 (CPAP) 残留气道压力）AHI 大于 20/h。非常严重的OSA患者舌后间隙狭窄，框架受限，难以通过常规悬雍垂腭咽成形术（UPPP）手术扩大，导致对非框架手术的反应较差。我们的最新报告显示了在一阶段多层次手术中接受单层闭合的改良 Z 型腭成形术 (ZPP) 的受试者的疗效和效率。目前尚不清楚该手术是否以及如何帮助患有非常严重的以受限框架为特征的 OSA 的患者。 2015年3月至2018年5月，我们入组了12例非常严重的OSA患者，接受一期多层手术，采用改良ZPP一层闭合、CO2激光部分舌根舌切除术和双侧鼻中隔成形术。我们的结果表明，手术将 AHI 从 73.8 ± 10.7 事件/小时减少到 30.8 ± 23.2 事件/小时，平均 AHI 减少了 58.3%（ p < 0.001 与 0 减少或无手术相比）。手术改变了呼吸障碍的组成部分。它减少的呼吸暂停多于呼吸不足，并且可能将一些呼吸暂停转化为呼吸不足。