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. 2009 Sep;84(9):795-800.
doi: 10.4065/84.9.795.

Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience

Akram Khan  1 , Kannan Ramar, Supriya Maddirala, Oren Friedman, John F Pallanch, Eric J Olson
Affiliations

Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience

Akram Khan et al. Mayo Clin Proc. 2009 Sep.

Abstract

Objective: To assess the role of uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea (OSA) using polysomnography (PSG) data within 6 months before and after surgery.

Patients and methods: We analyzed PSG and body mass index (BMI) data from patients with OSA who were 18 years or older and who underwent UPPP between January 1, 1988, and August 31, 2006.

Results: Sixty-three patients (51 men [81.0%]; mean +/- SD age, 42.1+/-13.9 years; mean +/- SD BMI, 34.9+/-7.2) underwent PSG a mean +/- SD of 50+/-47 days before and 88.5+/-34.0 days after UPPP. Surgical cure was defined as a postoperative apnea-hypopnea index (AHI) of 5 or less. Fifteen patients (24%) achieved a surgical cure. Twenty-one patients (33%) had a postoperative AHI of 10 or less, whereas 32 (51%) achieved a 50% or greater reduction in AHI and/or an AHI of 20 or less. No significant changes were noted in BMI before and 6 months after UPPP. Patients who attained an AHI of 5 or less were younger (mean +/- SD age, 35.9+/-13.1 vs 44+/-13.7 years; P=.05), had lower BMIs (mean +/- SD, 30.8+/-6.5 vs 34.6+/-6.6; P=.05), and had less severe OSA (mean +/- SD AHI, 38.1+/-33.6 vs 69.6+/-32.8; P=.004). Of the 48 patients (76%) with a post-UPPP AHI greater than 5, 35 (56%) received continuous positive airway pressure, with a mean reduction in pressure of 1.4 cm H(2)O (95% confidence interval, -0.4 to -2.4 cm H(2)O).

Conclusion: Independent of changes in BMI, in our retrospective analysis, UPPP achieved an AHI of 5 or less in 24% and an AHI of 10 or less in 33% of patients with OSA who underwent PSG 6 months before and after surgery. In those with residual OSA who received continuous positive airway pressure, the required pressure setting decreased by 1.4 cm H(2)O.

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Figures

FIGURE 1.
FIGURE 1.
Box and whisker plot. Mean (open diamonds) and median (horizontal lines) preoperative (preop) (dark bars) and postoperative (postop) (cross-hatched bars) polysomnography (PSG) data for 63 patients who underwent uvulopalatopharyngoplasty (UPPP). AHI = apnea-hypopnea index; LD = lateral decubitus; MOS = minimum oxygen saturation; NREM = nonrapid eye movement; REM = rapid eye movement; S = supine. Whiskers indicate minimum and maximum values.
FIGURE 2.
FIGURE 2.
Box and whisker plot. Mean (open diamonds) and median (horizontal lines) population characteristics of patients with a postoperative apnea-hypopnea index (AHI) of 5 or less (n=15) (dark bars) and a postoperative AHI greater than 5 (n=48) (cross-hatched bars) after uvulopalatopharyngoplasty (UPPP). BMI = body mass index; MOS = minimum oxygen saturation; PSG = polysomnography. Whiskers indicate minimum and maximum values.
See this image and copyright information in PMC

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