Unpredictable results of laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnoea

Abstract

Background-Laser assisted uvulopalatoplasty (LAUP) is increasingly oVered for the treatment of obstructive sleep apnoea (OSA), although there is a lack of objective data to support its indications and eYcacy. A study was undertaken to determine the treatment response to LAUP. Methods-Overnight polysomnography was performed before and at least three months after surgery in 44 consecutive patients with symptomatic mild to moderate OSA (apnoea + hypopnoea index (AHI) >10/h). Pharyngeal dimensions were measured by videoendoscopy (n = 11) and disease-specific quality of life, sleepiness and snoring frequency (n = 16) before and after surgery were determined in subgroups of patients. LAUP was performed under local anaesthesia as a one stage resection of the uvula and soft palate by one of two experienced otolaryngologists. Results-Twelve patients (27%) had a good response (AHI <10/h after LAUP); four (9%) had a partial response (AHI <50% of pre-LAUP value); 15 (34%) had a poor response (AHI >50% of pre-LAUP value); and 13 (30%) patients were worse (AHI >100% of pre-LAUP value). The velopharyngeal cross sectional area and anteroposterior diameter increased following LAUP (p<0.05). Quality of life indices improved significantly in all domains and sleepiness decreased. The snoring index did not decrease significantly. No preoperative anthropometric or videoendoscopic measures were predictive of a good response to LAUP. Patients who were worse after LAUP had milder baseline apnoea severity than those in the other response groups. Conclusions-The treatment response to LAUP is variable and unpredictable, and only a few patients achieve a satisfactory response. There appears to be no relationship between subjective and objective measures of treatment eYcacy. (Thorax 2000;55:399-404)

Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations?

“…It goes without saying that objective snoring recordings have to be reliable. Some studies have shown objective reductions in snoring after LAUP [3,5], while others have not [4]. This raises the question of whether snoring recordings are reliable.…”

“…These studies showed subjective improvement in snoring. However, this improvement was not confirmed when objective measurements of snoring were used to assess the effectiveness of LAUP [4], thus arousing controversy. Moreover, the recently published analysis of the Standards of Practice Committee of the American Academy of Sleep Medicine [1] has drawn attention to the lack of conclusive evidence in support of this technique.…”

“…Benefits of LAUP for snoring have been evaluated in earlier studies [3][4][5][15][16][17][18][19][20][21]. These studies showed subjective improvement in snoring.…”

“…Its indication has probably been favoured by the widespread belief that surgical procedures are more decisive. Furthermore, disparate results concerning this procedure have been published on the basis of objective measurements of snoring before and after treatment [3][4][5]. This, together with the potential risks and complications of LAUP [1], has cast doubt on the need for treating nonapnoeic snorers [6], and the high cost of treating a growing number of patients has led to the usefulness of LAUP being challenged.…”

Surgical Therapy of Obstructive Sleep Apnea: A Review

“…This procedure has a high success in reducing snoring (approximately 90 %), but is not recommended for the treatment of OSA, because of unpredictable results and even worsening OSA [31,32].…”