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OUTCOMES OF UVULOPALATOPHARYNGOPLASTY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Mayo Clinic, Rochester, MN

PURPOSE: Uvulopalatopharyngoplasty (UPPP) is a treatment option for patients with obstructive sleep apnea syndrome (OSA). Results of UPPP have been inconsistent and its effectiveness remains unclear. We conducted a retrospective analysis to evaluate the success of UPPP in treating patients with OSA at Mayo Clinic.

METHODS: Charts were reviewed for 978 patients with OSA who underwent UPPP between January 1988 and August 2005. Patients aged 18-80 who underwent UPPP, and were assessed with polysomnography (PSG) within a six-month period, pre and post procedure, were included in this analysis.

RESULTS: Final analysis included 63 patients, 51 males and 12 females with an average age of 42.1 (±13.9) years and an average body mass index (BMI) of 33.7 (± 6.7) kg/m2. UPPP resulted in a 54.8% reduction in the mean apnea-hypopnea index (AHI), from 62.6 (± 35.4) pre-operatively to 28.3 (± 28.9) post-operatively. The arousal index decreased 38.7%, from 58.3 (± 30.2) to 35.9 (± 22.3). Respiratory related-arousals decreased by 27.5%. The nadir oxygen saturation improved from 73.9% (± 17.1) to 80.7% (± 10.7) with a corresponding improvement in the percentage of time spent with oxygen saturation < 90% from 25.8% to 15.9%. Subjective snoring grade improved from 2.7 to 1.7 on side and from 2.9 to 2.2 on back based on a 0-4 scale. All changes were statistically significant with p<0.05. Fifteen patients (24.2%) had a post-operative AHI ; 5 and 21 (33.9%) a post-operative AHI ; 10. Of those with residual OSA, 7 refused CPAP (11.1%), and 35 (55.6%) accepted CPAP with a mean reduction in pressure of 1.4 (SE ± 0.49) cm H2O.

CONCLUSION: UPPP eliminates OSA in a third of patients and tends to decrease the required CPAP setting in those with residual OSA.

CLINICAL IMPLICATIONS: UPPP improves but usually does not completely resolve OSA. For those with residual OSA following UPPP who return to CPAP, pressure requirements will be modestly lower. The clinical significance of this observation is not clear.

DISCLOSURE: Akram Khan, No Financial Disclosure Information; No Product/Research Disclosure Information