Uvulopalatopharyngoplasty for the obstructive sleep apnoea syndrome: value of polysomnography, Mueller manoeuvre and cephalometry in predicting surgical outcome

Abstract

Sixty consecutive patients with the obstructive sleep apnoea syndrome (53 men and seven women) were analysed by questionnaire, polysomnography, röntgenographic cephalometry and the Mueller manoeuvre before and 6 months after uvulopalatopharyngoplasty (UPPP), to assess the surgical outcome and the prognostic value of preoperative evaluation. Seventy-three per cent of patients reported improvement of snoring and 55% reported improvement of excessive daytime sleepiness. Thirty-five per cent showed a decrease of at least 50% in the desaturation index, and 13% had a postoperative desaturation index below 5. Although the improvement of desaturation parameters was marked in some patients, the overall change was not significant. Neither the Body Mass Index (BMI), nor any of the cephalometric variables were significantly correlated to surgical outcome. Increased difference in collapsibility between the soft palate and the base of the tongue showed a close to significant relation with the improvement of desaturation index. High desaturation index, low mean saturation and deep lowest saturation were found to be slightly predictive of improvement in nocturnal desaturation. In a multivariate analysis however no significant predictors could be identified. It is concluded that UPPP is effective in reducing snoring and daytime sleepiness over a 6-month follow-up period, but that the overall improvement in nocturnal desaturation is limited and difficult to predict. Further research is needed to evaluate the long-term efficacy of UPPP.

Radiofrequency Ablation for the Treatment of Mild to Moderate Obstructive Sleep Apnea

“…Indeed, in the meta-analysis of Sher et al, 9 as well as in other publications, several factors were shown to give poorer results, especially in subjects with higher BMI, 11 nontreated sites of obstruction and severe OSAS. [11][12][13][14][15] Although Sher et al 9 and other authors 12,13 did not find any significant difference in BMI between UPPP success and failure, some authors, such as Chabolle et al, 11 showed that a BMI exceeding 27 kg/m 2 gave poorer results. Indeed, obesity can be responsible for UPPP failures because of factors that are not addressed by surgery: compromised respiration (overlap syndrome) 16 and excess compliance.…”

“…Indeed, in the meta‐analysis of Sher et al, 9 as well as in other publications, several factors were shown to give poorer results, especially in subjects with higher BMI, 11 nontreated sites of obstruction and severe OSAS. 11–15 …”

“…Although Sher et al 9 and other authors 12,13 did not find any significant difference in BMI between UPPP success and failure, some authors, such as Chabolle et al, 11 showed that a BMI exceeding 27 kg/m 2 gave poorer results. Indeed, obesity can be responsible for UPPP failures because of factors that are not addressed by surgery: compromised respiration (overlap syndrome) 16 and excess compliance.…”

The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients

“…[ Four out of 14 studies were not able to demonstrate any statistically significant predictor for monotherapy UPPP outcome [65][66][67][68]. The potentially predictive parameters presented in the remaining 10 studies were classified as described before (Table 6).…”

Long‐Term Results of Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome

“…Compared with other surgical procedures, UPPP is less invasive and relatively well tolerated, but the response rate as defined by different criteria predominantly based on respiratory parameters is approximately 50% or less on short‐term follow‐up. 2,3,8 The long‐term effectiveness of UPPP in OSAS has been investigated in a small number of studies, with the number of included patients ranging from 15 to 50. Improvement of snoring and daytime sleepiness is assessed on a subjective basis without a scaled reference and all studies consider different respiratory parameters to define response.…”