Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP

Abstract

Patients with obstructive sleep apnea (OSA) have decreased long-term survival. Treatment of OSA with either nasal continuous positive airway pressure (CPAP) or tracheostomy improves survival, but the effect of uvulopalatopharyngoplasty (UPPP) on survival is unclear. We attempted to contact all patients with OSA treated with either UPPP or nasal CPAP over a 6-year period to compare long-term survival between these two treatments. One hundred fifty-four patients had a UPPP during this period. Five of these patients were later treated with nasal CPAP and were excluded from the analysis. Twelve of the remaining 149 were unavailable for follow-up but were included in the analysis. Follow-up polysomnography was performed on 140 (94 percent) of these patients; 114 (81 percent) had either a postoperative apnea index < 5/h or > 50 percent reduction in apnea index. Two hundred eight patients were started on a regimen of nasal CPAP during the same period. Eighty-two patients discontinued nasal CPAP therapy and were excluded from analysis. Nine of the remaining 126 were unavailable for follow-up but were included in the analysis. Six patients treated with UPPP died. Three of these six patients had a 3-month follow-up polysomnogram that revealed apnea indices of 1/h, 5/h, and 23/h. Three patients treated with nasal CPAP died. There was no difference in the long-term survival between the two treatment groups. We conclude that there may be no difference in the long-term survival of patients with OSA between those treated with UPPP and those treated with nasal CPAP. This study emphasizes the importance of follow-up polysomnography in all patients after UPPP.