Changes in quality of life and respiratory disturbance after extended uvulopalatal flap surgery in patients with obstructive sleep apnea

Abstract

Objective: To evaluate the subjective and objective outcomes of extended uvulopalatal flap (EUPF) surgery in patients with obstructive sleep apnea.

Design: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Snore Outcomes Survey (SOS), Epworth Sleepiness Scale (ESS), and polysomnography were performed preoperatively and then 6 months postoperatively.

Setting: Tertiary care, sleep disorders referral center.

Patients: Fifty-five consecutive patients (52 men and 3 women; mean age, 45 years) with obstructive sleep apnea.

Intervention: EUPF surgery.

Main outcome measures: Overnight polysomnography variables included respiratory distress index (RDI), snore index, minimum oxygen saturation, sleep stages 1 and 2, sleep stages 3 and 4, rapid eye movement, and sleep efficiency. Questionnaire variables included SF-36, SOS, and ESS scores. Success of the operation was defined as a more than 50% reduction of the RDI from the initial value and a postoperative RDI of less than 20.

Results: The overall success rate of the EUPF surgery was 82%; the RDI, snore index, and minimum oxygen saturation improved significantly after surgery (P<.001). Sleep architecture in overnight polysomnography remained unchanged (P=.48 and P=.74). Patients demonstrated significant improvement in both their SOS and ESS scores (P<.001) and significant increases in 7 of 8 SF-36 subscales (P<.05 for all). However, there was poor correlation between the improvement in quality of life and the reduction in sleep-related respiratory events.

Conclusions: Extended uvulopalatal flap surgery can greatly reduce sleep-related adverse events and proves to be an effective therapy to enhance the quality of life of patients with obstructive sleep apnea. This study also suggests that subjective and objective outcomes are equally important when reporting the results of EUPF surgery.