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ISSN : 0376-4672
현재까지 폐쇄성 수면 무호흡증(obstructive sleepapnea syndrom:OSAS) 치료를 위한 수많은 방법(treatment modalities)들이 보고되고 있다. 이 치료 방법들은 비침습적(non-invasive)인 행동 조절(behavior modification)과 야간에 사용하는 지속적 상기도 양압술(continuous positive airwaypressure:CPAP)등에서부터 기도의 해부학적 구조를 바꾸는 침습적인(invasive) 치료에 이르기 까지 다양하다. 외과적 치료 방법을 결정하기까지는 개개 환자의 해부학적 형태나 생리학적 요소 등을 고려해야 하기에“복잡한 선택 및 배제의 연속적 과정”이라 할 수 있다. 즉 임상적 평가(clinical assessment), 환자의선호도(patient preference), 질환의 심각성(disease severity) 등을 고려하여 사용 가능한 치료방법들의 효용성(effectiveness)을 따져, 보다 나은결과를 얻을 수 있도록 노력해야 한다. 한편 이는 바꾸어 말하면 너무도 많은 치료 방법(treatmentoption)과 지침(guideline)이 있기에 술자와 환자는치료 방법을 결정하는데 있어 확신을 갖기 어렵고, 혼동을 하기 쉽다는 것을 의미하기도 한다1). 본 연구에서는 이렇듯 다양한 수술적 방법들에 대해서 소개하고 각치 료 방 법 들 의 적 응 증 (indication), 예 후(prognosis), 합병증(complication), 고려할 점(perioperative consideration) 등에 대해서 문헌고찰과 함께 논의하여 보다 더 나은 치료 방법에 대하여 알아보고자 한다.
Obstructive sleep apnea syndrom(OSAS) is defined by total or partial collapse of the upper airway during sleep. In the presence of specific anatomic features, OSAS is potentially amenable to surgical treatment. Initially, the only treatment available for these patients was a tracheotomy that bypassed the obstruction and resulted in a 100% cure. However, this was not readily accepted by most patients, and surgical methods other than tracheotomy were developed to successfully maintain adequate upper airway patency during sleep by comparing to postoperative polysomnography(AHI,RDI etc). In this paper, I would like to provide an overview of some of the multilevel surgical techniques available for treating OSAS as well as the necessary preoperative considerations.
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