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Randomized Controlled Trial
. 2016 Jan 11;113(1-02):1-8.
doi: 10.3238/arztebl.2016.0001.

Tonsillectomy with Uvulopalatopharyngoplasty in Obstructive Sleep Apnea

Ulrich J Sommer  1 , Clemens Heiser, Constanze Gahleitner, Raphael M Herr, Karl Hörmann, Joachim T Maurer, Boris A Stuck
Affiliations
Randomized Controlled Trial

Tonsillectomy with Uvulopalatopharyngoplasty in Obstructive Sleep Apnea

Ulrich J Sommer et al. Dtsch Arztebl Int. .

Abstract

Background: Obstructive sleep apnea (OSA) is a very common disorder (prevalence 2-7% in women, 7-14% in men). It impairs the quality of life and increases mortality. Conservative treatment with continuous positive airway pressure is highly effective, but patient compliance is variable. Surgical treatments are controversial, as only a few are supported by evidence from controlled clinical trials.

Methods: Adult patients with OSA, CPAP intolerance, and oropharyngeal obstruction were included in the trial. All underwent polysomnography (PSG) and were randomly allotted to one of two groups. Patients in the treatment group underwent tonsillectomy with uvulopalatopharyngoplasty (TE-UPPP) within one month. All patients had a follow-up PSG at three months, and all PSGs were evaluated in blinded fashion. The primary outcome variable was the apneahypopnea index (AHI) as determined by PSG. Other outcome variables were subjective symptoms (daytime sleepiness, quality of life), complications, and patient satisfaction.

Results: 42 patents were included in the trial (23 in the treatment group, 19 in the control group). The baseline AHI was 35.7 ± 19.4/hr in the control group and 33.7 ± 14.6/hr in the treatment group. The corresponding figures at 3 months were 28.6 ± 19.4/hr in the control group and 15.4 ± 14.1/hr in the treatment group (p = 0.036). The intervention also led to significant improvement in daytime sleepiness and in snoring, according to the patients' and their bed partners' assessment. 97% of the patients who underwent surgery were satisfied with the outcome. 65% of them needed no further treatment for OSA.

Conclusion: TE-UPPP significantly improved apnea/hypopnea, daytime sleepiness, and snoring compared to control (i.e., no) treatment. It is a safe and effective treatment for OSA..

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Figures

Figure 1
Figure 1
Diagram of trial procedure. Bottom: control group; top: treatment group. PSG: Polysomnogram
Figure 2
Figure 2
Typical preoperative and postoperative site in tonsillar hypertrophy: a) Preoperative b) Postoperative. Resorbable sutures used to reconfigure the oropharynx are clearly visible.
Figure 3
Figure 3
Box-and-whisker plot showing change in Apnea–Hypopnea Index (AHI) at V0, V2, and V3. Whisker length indicates interquartile range; box length indicates doubled interquartile range. Outliers are marked. “Baseline value” indicates V0 for the control group. “Before surgery” denotes V2 for the control group and V0 for the treatment group. “After surgery” denotes V3 for the control group and V2 for the treatment group. Intra-individual changes in this parameter are shown in eFigure 1.
Figure 4
Figure 4
Box-and-whisker plot showing change in snoring score as assessed by bed partner at V0, V2, and V3. Whisker length indicates interquartile range; box length indicates doubled interquartile range. Outliers are marked. “Baseline value” indicates V0 for the control group. “Before surgery” denotes V2 for the control group and V0 for the treatment group. “After surgery” denotes V3 for the control group and V2 for the treatment group. Intra-individual changes in this parameter are shown in eFigure 2.
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Comment in

  • Reasons for Refusal Were not Given.
    Boentert M. Boentert M. Dtsch Arztebl Int. 2016 Jul 11;113(27-28):484. doi: 10.3238/arztebl.2016.0484a. Dtsch Arztebl Int. 2016. PMID: 27476708 Free PMC article. No abstract available.
  • Further Long-term Studies Are Required.
    Young P. Young P. Dtsch Arztebl Int. 2016 Jul 11;113(27-28):484-5. doi: 10.3238/arztebl.2016.0484b. Dtsch Arztebl Int. 2016. PMID: 27476709 Free PMC article. No abstract available.

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