Modified uvulopalatopharyngoplasty and coblation channeling of the tongue for obstructive sleep apnea: a multi-centre Australian trial

Abstract

Study objectives: To investigate the surgical outcomes and efficacy of modified uvulopalatopharyngoplasty (mod UPPP) and Coblation channelling of the tongue (CCT) as a treatment for obstructive sleep apnea (OSA).

Methods: Adult patients with simple snoring or obstructive sleep apnea were treated with combined modified UPPP, bilateral tonsillectomy, and CCT (N = 48). Full polysomnography was performed preoperatively and 3 months postoperatively. Postoperative clinical assessment, sleep questionnaires, and patient demographics including body mass index were compared to preoperative data. All polysomnograms were re-scored to AASM recommended criteria by 2 sleep professionals.

Results: The preoperative AHI (median and interquartile range) of 23.1 (10.4 to 36.6) was lowered to a postoperative AHI of 5.6 (1.9 to 10.4) (p < 0.05). The Epworth Sleepiness Scale score fell from 10.5 (5.5 to 13.5) to 5.0 (3.09 to 9.5) (p < 0.05). Morbidity of the surgery was low, with no long-term complications recorded.

Conclusions: Modified UPPP combined with CCT is a highly efficacious intervention for OSA with minimal morbidity. It should be considered for individuals who fail or are intolerant of CPAP or other medical devices.

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Figure 1. Comparison of preoperative and postoperative apnea hypopnea index (AHI)

Significant improvements in the AHI were observed following surgery. (A) Dot plots representing individual patient AHI result before and after surgery. Data presented for each surgeon and for both surgeons together (combined). (B) Box plot representing median, interquartile range, minimum, and maximum of AHI measurements for the combined data set, with patients tonsil size and palate (relative to tongue) position categorized according to Friedman (FRG) stage. *p < 0.05 related-samples Wilcoxon signed ranks test. N = 21 Surgeon 1, N = 27 Surgeon 2, N = 48 combined. N = 17, 23, 7, 1 for FRG class 1, 2, 3, 4, respectively.

Figure 2. Comparison of preoperative and postoperative Epworth Sleepiness Scale (ESS)

Significant improvements in ESS were observed following surgery. (A) Dot plots representing individual patient ESS result before and after surgery. Data presented for each surgeon and for both surgeons together (combined). (B) Box plot representing median, interquartile range, minimum, and maximum of ESS measurements for the combined data set, with patients tonsil size and palate (relative to tongue) position categorized according to the Friedman (FRG) stage. *p < 0.05 related-samples Wilcoxon signed ranks test. N = 21 Surgeon 1, N = 27 Surgeon 2, N = 48 combined. N = 17, 23, 7, 1 for FRG class 1, 2, 3, 4, respectively.

Figure 3. Comparison of preoperative and postoperative lowest saturated oxygen (LSaO₂)

Significant improvements in LSaO₂ were observed following surgery. (A) Dot plots representing individual patient LSaO₂ result before and after surgery. Data presented for each surgeon and for both surgeons together (combined). (B) Box plot representing median, interquartile range, minimum and maximum of LSaO₂ measurements for the combined data set, with patients tonsil size and palate (relative to tongue) position categorized according to the Friedman (FRG) stage. *p < 0.05 related-samples Wilcoxon signed ranks test. N = 21 Surgeon 1, N = 27 Surgeon 2, N = 48 combined. N = 17, 23, 7, 1 for FRG class 1, 2, 3, 4, respectively.

Figure 4. Comparison of preoperative and postoperative body mass index (BMI)

No significant changes in BMI were observed following surgery. (A) Dot plots representing individual patient BMI score before and after surgery. Data presented for each surgeon, and for both surgeons together (combined). (B) Box plot representing median, interquartile range, minimum, and maximum of BMI measurements for the combined data set, with patients tonsil size and palate (relative to tongue) position categorized according to the Friedman (FRG) stage. N = 21 Surgeon 1, N = 27 Surgeon 2, N = 48 combined. N = 17, 23, 7, 1 for FRG class 1, 2, 3, and 4, respectively.