ABSTRACT
In Group 1a, the mean rapid eye movement (REM) and non-REM (NREM)
apnea-hypopnea indices (AHI) dropped from 79.7 and 59.3 to 5.7 and 8.9, respec-
tively, with the tracheotomy open postoperatively. In Group 1b, (cardiopulmonary
decompensation and morbid obesity) tracheotomy showed dramatic improvement
but the AHI remained in the 30-40 range. The mean REM and NREMAHI fell from
102.3 and 57.8 to 30.6 and 39.2, respectively. Group 2 patients showed posttracheot-
omy PSG differences between the capped and uncapped AHI. The REM and NREM
AHI drop was similar to Group 1a, from 57.1 and 80.2 to 5.3 and 1.7, respectively.
These results are summarized in Table 3. Group 1b (with cardiopulmonary decom-
pensation and morbid obesity) improved less in this study compared to the other
groups (28). This difference could be due to fat and skin obstruction, poor tracheot-
omy fit, central apnea that corrected beyond the length of the study, or other physio-
logic factors associated to cardiopulmonary health. Thatcher’s long-term longitudinal cohort study of 79 patients suggests tra-
cheotomy for severe OSA is very effective and well tolerated in the long term. Sig-
nificant morbidity and mortality are low and complications of tracheotomy are
well tolerated and easily treated. Decannulation in Thatcher and Maisel’s (8) and
Guilleminault et al.’s (26) studies is unlikely even in cases with resolution of OSA.
Severe OSA patients who undergo tracheotomy should have concurrent UPPP
and weight counseling if decannulation is anticipated. Tracheotomy patients who
meet criteria for gastric bypass surgery should be considered for this type of treat-
ment to enhance the probability of decannulation.
