Efficacy of Uvulopalatopharyngoplasty in Unselected Patients with Mild Obstructive Sleep Apnea

Senior, Brent A.; Rosenthal, León; Lumley, Alicia; Gerhardstein, Rebecca; Day, Ryan

doi:10.1067/mhn.2000.106707

Cited by 72 publications

(66 citation statements)

References 10 publications

(21 reference statements)

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“…The overall success rate from mild to severe OSA is reported to be approximately 40 % [9]. Several factors including tongue position, tonsil size, BMI, site of pharyngeal narrowing and severity of the disease have been shown related to the surgical success or failure [10][11][12]. Recently, Zhang et al [13] reported the results of consecutive 119 patients who underwent velopharyngeal surgery including revised UPPP with transpalatal advancement pharyngoplasty.…”

Section: Discussionmentioning

confidence: 96%

“…The study provides evidence that the ST 90 is a unique independent predictor of surgical success with a high sensitivity and high NPV, and can be used by clinicians to allow better selection of patients to achieve maximal outcomes. Several studies have assessed the procedural outcomes and predictors of success in OSA surgery [9][10][11][12][13][14][15][16]. However, the surgical approaches evaluated in these studies vary greatly.…”

Section: Discussionmentioning

confidence: 99%

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Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

Turhan

Bostancı

Bozkurt

2014

Eur Arch Otorhinolaryngol

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The purpose of this study was to investigate the relationship between various polysomnographic variables and the success of modified tongue base suspension combined with uvulopharyngopalatoplasty in patients with severe obstructive sleep apnea (OSA). A total of 90 patients who had apnea hypopnea index (AHI) >30 and had both oropharyngeal and hypopharyngeal obstruction were included in this prospective case series with planned data collection. All patients were assessed preoperatively and at the sixth postoperative month by polysomnography. The surgery was considered to be successful when a ≥50% reduction in the mean AHI to a final AHI of <20/h was obtained. Multiple logistic regression analyses were performed to determine the impact of variables on the surgical success. A total of 67 patients (74.4%) met the surgical success criteria. The univariate analysis revealed a relationship between success and AHI (P = 0.001), obstructive apnea duration (P = 0.001), sleep time with oxygen saturation below 90% (ST90) (P = 0.004), minimum O2 saturation (P = 0.0001), mean O2 saturation (P = 0.011), mean O2 desaturation (P = 0.0001), and oxygen desaturation index (P = 0.001). However, ST90 [OR (95% CI) = 1.40 (1.04-1.89), P = 0.023] was the only independent parameter predicting the surgical success in multivariate analysis. The ROC analysis revealed that the ST90 value of ≤36 min was the best cutoff value with 96.97% sensitivity (CI 89.5-99.6), 95.83% specificity (CI 78.9-99.9), 98.5% PPV (CI 91.6-100.0), and 92.0% NPV (CI 74.0-99.0). The stratification of patients with severe OSA according to the ST90 may allow better identification of patients in whom surgical success is probable.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

Turhan

Bostancı

Bozkurt

2014

Eur Arch Otorhinolaryngol

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“…It was thought that surgery should be reserved for patients with mild/ moderate disease, rather than severe disease. However, studies have shown that UPPP is not more effective in treating patients with mild disease, and can even worsen objective parameters such as the apnea-hypopnea index [6,7] .…”

Section: Discussionmentioning

confidence: 99%

Updated Friedman Staging System for Obstructive Sleep Apnea

Friedman

Salapatas

Bonzelaar

2017

Advances in Oto-Rhino-Laryngology

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In the practice of sleep medicine, the first step is identification of those patients at high risk for sleep apnea. Nearly every physician and every hospital has preferred methods of screening. Many patient questionnaires or surveys as well as some objective physical measurements have been suggested to predict the presence of sleep apnea. Screening is well established, and laboratory and home testing are widely available. An early assessment with a physical examination can help direct treatment planning. The Friedman tongue position, lingual tonsil hypertrophy grading, and the effects of oral positioning on the hypopharynx should be used in early assessment for treatment planning, and as screening tools to assess the sight of obstruction. Although these screening tools are not substitutes for drug-induced sleep endoscopy (DISE), they are crucial in early assessment as many patients do not require surgery or DISE early in the evaluation.

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“…Surgeons must use great care in discerning the level of obstruction in the patient with mild OSA to achieve excellent surgical outcomes. 11 A prospective randomised study, which compared mandibular advancement appliance with surgery to the soft palate, indicates a success rate of 95% with MAA and 70% with UPPP. 12 Although the patient had previously undergone soft palate reduction, he still opted for orthognathic mandibular advancement, as he did not wish to be committed to protracted use of a mandibular advancement appliance.…”

Section: Discussionmentioning

confidence: 99%

The role of orthodontics and oral and maxillofacial surgery in the management of obstructive sleep apnoea — a single case report

2004

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Obstructive sleep apnoea (OSA) is a potentially fatal breathing disorder, yet is widely under-diagnosed. It is a multifactorial condition associated with high morbidity, a degree of mortality and is associated with an increase risk of car crashes. A case is presented which demonstrates the inter-disciplinary approach to this condition and the successful treatment through mandibular advancement by orthodontic means followed by orthognathic surgery. The experience of this patient illustrates the importance of the disciplines of orthodontics and oral and maxillofacial surgery in the multidisciplinary management of these patients.

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Efficacy of Uvulopalatopharyngoplasty in Unselected Patients with Mild Obstructive Sleep Apnea

Cited by 72 publications

References 10 publications

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

Updated Friedman Staging System for Obstructive Sleep Apnea

The role of orthodontics and oral and maxillofacial surgery in the management of obstructive sleep apnoea — a single case report

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