Long‐term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty

Friberg, Danielle; Sundman, Joar; Browaldh, Nanna

doi:10.1002/lary.27917

Cited by 16 publications

(10 citation statements)

References 19 publications

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“…In addition, daytime sleepiness, a major symptom of OSA, improved and remained improved in the long term (ESS < 10 in 85% of patients at 8 years post‐UPPP). These beneficial subjective results were also reported in another study of the same cohort, with a high number of satisfied patients (83% at 2 years) 15 …”

Section: Discussionsupporting

confidence: 81%

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

et al. 2020

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Uvulopalatopharyngoplasty (UPPP) is the most common surgical treatment for adult patients with obstructive sleep apnea (OSA). Its short-term efficacy, as measured through polysomnography, is well-established and has been demonstrated in two randomized controlled trials in recent years. However, less is known about subjective sleep quality, longterm efficacy, and side effects after surgery. In addition, the reliability of the most widespread clinical test for selecting patients for surgery-the Friedman staging system-is unclear. The Friedman staging system uses a combination of tonsil size and tongue position to predict the likelihood of successful surgery. The objective of studies I and II was to evaluate the staging system by determining its inter-examiner agreement. In study I, 15 doctors evaluated the system by using it on each other. In study II, 14 doctors evaluated the system by using it on 12 patients with OSA. Cohen's kappa analysis was used. Kappa values of 1 represents perfect agreement, and values of 0 represent no more agreement than would have been expected through random chance. In study I, the median kappa was 0.36 for tongue position. In study II, the median kappa was 0.32 for tongue position, 0.62 for tonsil size, and 0.38 for the Friedman staging system. These findings correspond to poor agreement, indicating that the system is an uncertain method for selecting patients for UPPP. Uvulopalatopharyngoplasty was first described in the eighties. Since then, there has been several modifications. The modified UPPP used in this thesis includes a tonsillectomy and is performed with cold instruments. It is less radical to the palate compared to the original procedure. The objective of study III was to investigate whether modified UPPP improves sleep quality by using the Functional Outcomes of Sleep Questionnaire and the Karolinska Sleep Questionnaire. The study consisted of two parts: Part 1 was a randomized controlled trial with two study groups (intervention and controls), and Part 2 was a post-operative follow-up of all patients (intervention and controls who received delayed surgery) with an analysis of outcomes at six and 24 months after UPPP. In eight out of nine subscales, there were significant improvements between the intervention and controls in favor of UPPP. In addition, at the six-and 24-month post-operative follow-ups of all patients, eight out of nine subscales were significantly improved compared to the baseline. These findings suggest a real and lasting beneficial effect of UPPP on subjective sleep quality, although a placebo effect cannot be excluded.

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Section: Discussionsupporting

confidence: 81%

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

et al. 2020

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“…Swallowing and speech disorders have not been previously well documented after APP in children, but surgical treatment in adults, for example, uvulopalatopharyngoplasty, is known to affect speech and swallowing [23]. In the present study there were no significant differences regarding impaired speech or swallowing, but the study was not powered for these outcomes, and notably, there were three children who reported impaired speech after APP compared to none after ATE.…”

Section: Discussioncontrasting

confidence: 60%

Postoperative morbidity after adenotonsillectomy versus adenopharyngoplasty in young children with obstructive sleep apnea: an RCT

Fehrm

Borgström

Nerfeldt

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose In our previous randomized controlled trial (RCT), comparing adenotonsillectomy (ATE) with adenopharyngoplasty (APP) in children with severe obstructive sleep apnea (OSA), there were no differences in respiratory sleep parameters or quality of life. The purpose of the present report was to evaluate postoperative morbidity from this RCT. Methods The study was a blinded RCT in 83 children (ATE = 47; APP = 36), 2–4 years of age, with an obstructive apnea–hypopnea index of ≥ 10. Pain was assessed from the first until the tenth day after surgery with a logbook that reported pain by child (FPS-R, Faces Pain Scale-Revised) and caregiver (visual analogue scale), analgesic use, return to normal diet, and weight change. Bleeding, infection, satisfaction with treatment, speech, and swallowing were assessed with a questionnaire and medical records 6 months after surgery. Results Sixty-four children (77%) returned the logbook and 65 (78%) answered the questionnaire. The median (interquartile range) day the children graded themselves as pain free (FPS-R = 0) was 7 (6–10) after ATE, compared with 9 (7 to > 10) after APP (p = 0.018). There were no other significant differences between the groups regarding any other pain-related outcomes, bleeding, infection, satisfaction, swallowing, or speech, but three children (11%) reported impaired speech after APP compared to none after ATE (p = 0.067). Conclusion The results regarding postoperative morbidity were in favor of ATE and the results from our previous report showed no advantages of APP. Therefore, APP should not be recommended in young, otherwise healthy children with OSA.

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“…Swallowing and speech disorders after APP are not well documented but are well-reported in adults who have received UPPP 151 . While the sample size in Paper III was too small to yield conclusive results, three children reported impaired speech after APP compared to none after ATE.…”

Section: Papers II and Iii -Is Adenopharyngoplasty Better Than Adenotmentioning

confidence: 99%

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Fehrm

Nerfeldt

Browaldh

et al. 2020

JAMA Otolaryngol Head Neck Surg

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Long‐term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty

Cited by 16 publications

References 19 publications

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

Postoperative morbidity after adenotonsillectomy versus adenopharyngoplasty in young children with obstructive sleep apnea: an RCT

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

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