Increase of the apnoea-hypopnoea index after uvulopalatopharyngoplasty: analysis of failure1

Abstract

From 70 patients who had uvulopalatopharyngoplasty (UPPP) operation and a pre- and postoperative sleep registration, we could retrospectively determine the failures and the correlation between variables such as age, gender, body mass index (BMI), earlier or concomitant tonsillectomy, unilevel (uvula-palate-tonsil) or multilevel (base of tongue as well) obstruction during sleep endoscopy and treatment outcome. From 70 patients, the preoperative sleep registration classified 15 social unacceptable snorers and 55 obstructive sleep apnoea syndrome (OSAS) patients. In this study we focused on the OSAS patients. From the 55 OSAS patients, 32 were classified as successful after UPPP, because they had a decreased apnoea-hypopnoea index (AHI) after surgery (</=20). Eight patients had a decreased AHI, but more than 20 apnoeas/hypnoeas per hour. Fifteen patients were identified as UPPP failures with an equal or increased AHI and/or subjective deterioration of snoring. We were unable to find a statistically difference between the two groups with respect to variables such as age, BMI and AHI preoperative (P > 0.56) as between the level of obstruction(s) (P > 0.24). For earlier or concomitant tonsillectomy we found a statistically difference (P > 0.039), but a very small number in the high failure group (n = 8). We conclude that although sleep endoscopy adds to better patient selection and better results, paradoxically, the finding of obstruction on palate-uvula level during sleep endoscopy can still give UPPP failures.

Drug-induced sleep endoscopy: the VOTE classification

“…The VOTE classification differs slightly from what we have developed independently for use in our practice [8,10,15,16] as it reflects the most fundamental aspects of the DISE evaluation. It does not prevent the addition of centerspecific assessments, but using a core classification and reporting the findings will advance our understanding of DISE, which has been limited to some extent by the wide diversity of systems in use around the world.…”

“…Studies show that subjects with palatal obstruction alone (vs. multilevel obstruction) on DISE had better outcomes after palate surgery [9,10], and the resolution of airway obstruction with manual mandibular advancement under sedation is associated with improved outcomes with treatment using mandibular repositioning appliances [11,12]. However, in spite of over two decades of experience, important clinically relevant questions remain unanswered.…”

Loop Gain Predicts the Response to Upper Airway Surgery in Patients With Obstructive Sleep Apnea

“…For instance, surgical failure can result despite an apparently favorable preoperative anatomical milieu. 10 The crucial missing information is an understanding both of the dominant pathophysiological mechanisms responsible for airway obstruction in a given patient (particularly nonanatomical at baseline in responder versus nonresponder groups; ^post surgery in responder versus nonresponders. Independent samples t-test for parametric data, Mann-Whitney U for nonparametric unpaired data, Wilcoxon signed rank for nonparametric paired data.…”

“…Several investigators have previously attempted to use anthropomorphic, 3 polysomnographic (PSG), 4,5 and anatomical [6][7][8][9] factors to predict success, but each of these do not have sufficient accuracy to be applied in clinical practice. 10 As such, there is significant motivation to better understand the mechanistic factors that determine surgery success and, as a result, to develop methods which reliably predict the patients who will respond favorably to upper airway surgery.…”

The Utility of Sleep Endoscopy in Adults with Obstructive Sleep Apnea: A Review of the Literature

“…Multivariate logistic regression analysis revealed the presence of a complete circumferential collapse at the velum or a complete anteroposterior collapse at tongue base to be independent predictors of upper airway surgery failure. Earlier studies have shown that subjects with palatal obstruction alone versus multilevel obstruction on DISE had better outcomes after palate surgery [48,49].…”