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Published in: European Archives of Oto-Rhino-Laryngology 2/2013

01-02-2013 | Rhinology

Is uvulopalatopharyngoplasty still an option for the treatment of obstructive sleep apnea?

Authors: Adriano Braga, Luiz H. Carboni, Tassiana do Lago, Daniel S. Küpper, Alan Eckeli, Fabiana C. P. Valera

Published in: European Archives of Oto-Rhino-Laryngology | Issue 2/2013

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Abstract

Uvulopalatopharyngoplasty (UPPP) has been widely described as a surgical option for the treatment of obstructive sleep apnea syndrome. Several studies have demonstrated variable success rates, and different criteria have been used to define success of surgery. The aim of the present study was to assess the efficiency of UPPP by polysomnography and to correlate it to the clinical findings. Also, we correlated to the various studies dealing with this topic, considering the different criteria adopted in each of this. Sixty-four patients were included in the study. The efficiency of surgery for UPPP was analyzed to the variables such as body mass index, age, preoperative polysomnography results and follow-up period. Based on the criteria for postoperative cure, the success rate was 44 %. Younger patients presented a better success rate than older ones. No other correlation was found between clinical findings and UPPP success. UPPP can be curative in some patients, but combination with other treatment modalities must be considered. This should be mentioned to the patients, since in many cases the sites of airway collapse may be multiple and no clinical aspect (except for age) is indicative of good prognosis.
Literature
1.
go back to reference Guilleminault C, Tilkian A, Dement WC (1976) The sleep apnea community-based study. Sleep heart health study. JAMA syndromes. Annu Rev Med 27:465–484PubMedCrossRef Guilleminault C, Tilkian A, Dement WC (1976) The sleep apnea community-based study. Sleep heart health study. JAMA syndromes. Annu Rev Med 27:465–484PubMedCrossRef
2.
go back to reference American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689 American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689
3.
go back to reference StrolloJr PJ, Rogers RM (1996) Current concepts: obstructive sleep apnea. NEngl J Med 334:99–104CrossRef StrolloJr PJ, Rogers RM (1996) Current concepts: obstructive sleep apnea. NEngl J Med 334:99–104CrossRef
4.
go back to reference Committee DCS and Committee DCS (2005) International classification of sleep disorders-2: diagnostic and coding manual. In: Thorpy MJ (ed) American Academy of Sleep Medicine Committee DCS and Committee DCS (2005) International classification of sleep disorders-2: diagnostic and coding manual. In: Thorpy MJ (ed) American Academy of Sleep Medicine
5.
go back to reference Badr MS (1998) Pathophysiology of upper airway obstruction during sleep. Clin Chest Med 19(1):21–32PubMedCrossRef Badr MS (1998) Pathophysiology of upper airway obstruction during sleep. Clin Chest Med 19(1):21–32PubMedCrossRef
6.
go back to reference Vilaseca I, Morello A, Montserrat JM et al (2002) Usefulness of uvulopalatophangoplasty whit genioglossus and hyoid advancement in the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 128(4):435–440PubMed Vilaseca I, Morello A, Montserrat JM et al (2002) Usefulness of uvulopalatophangoplasty whit genioglossus and hyoid advancement in the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 128(4):435–440PubMed
7.
go back to reference Blumen MB, Dahan S, Fleury B et al (2002) Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea. Laryngoscope 112(11):2086–2092PubMedCrossRef Blumen MB, Dahan S, Fleury B et al (2002) Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea. Laryngoscope 112(11):2086–2092PubMedCrossRef
8.
go back to reference Verse T, Maurer JT, Pirsig W (2002) Effect of nasal surgery on sleep related breathing disorders. Laryngoscope 112(1):64–68PubMedCrossRef Verse T, Maurer JT, Pirsig W (2002) Effect of nasal surgery on sleep related breathing disorders. Laryngoscope 112(1):64–68PubMedCrossRef
9.
go back to reference Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively surgical patients. Otolaryngol Head Neck Surg 108(2):117–125PubMed Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively surgical patients. Otolaryngol Head Neck Surg 108(2):117–125PubMed
10.
go back to reference Santos Junior J, Zonato AI, Martinho FL, Gregório LC, Miranda S (2001) Mandibular anterior osteotomy whit chin advancement for treatment of obstructive sleep apnea syndrome in patients whit mandibular retrognathism: report a case. Revista Hypnos 2:29–33 Santos Junior J, Zonato AI, Martinho FL, Gregório LC, Miranda S (2001) Mandibular anterior osteotomy whit chin advancement for treatment of obstructive sleep apnea syndrome in patients whit mandibular retrognathism: report a case. Revista Hypnos 2:29–33
11.
go back to reference Gooday RH, Percious DS, Morrison AD et al (2001) Obstructive sleep apnea syndrome: diagnosis and management. J Am Dent Assoc 67(11):652–658 Gooday RH, Percious DS, Morrison AD et al (2001) Obstructive sleep apnea syndrome: diagnosis and management. J Am Dent Assoc 67(11):652–658
12.
go back to reference Fujita S, Conway W, Zorick F et al (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89:923–934PubMed Fujita S, Conway W, Zorick F et al (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89:923–934PubMed
13.
go back to reference Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper-airway in adults with obstructive sleep apnea syndrome. Sleep 19(2):156–177PubMed Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper-airway in adults with obstructive sleep apnea syndrome. Sleep 19(2):156–177PubMed
14.
go back to reference Friedman et al (2004) Staging of obstructive sleep apnea/hypopnea syndrome. Laryngoscope 114(3):454–459PubMedCrossRef Friedman et al (2004) Staging of obstructive sleep apnea/hypopnea syndrome. Laryngoscope 114(3):454–459PubMedCrossRef
15.
go back to reference Powell NB, Guilleminault C, Riley RW (1994) Principles and practice of sleep medicine. W.B. Saunders Company, Philadelphia, pp 706–721 Powell NB, Guilleminault C, Riley RW (1994) Principles and practice of sleep medicine. W.B. Saunders Company, Philadelphia, pp 706–721
16.
go back to reference Reimão R, Joo SH (2000) Mortalidade da apnéia obstrutiva do sono. Rev Assoc Med Bras 46(1):52–56PubMedCrossRef Reimão R, Joo SH (2000) Mortalidade da apnéia obstrutiva do sono. Rev Assoc Med Bras 46(1):52–56PubMedCrossRef
17.
go back to reference Keenan S, Burt H, Ryan F, Fleetham JA (1994) Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest 105:155–159PubMedCrossRef Keenan S, Burt H, Ryan F, Fleetham JA (1994) Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest 105:155–159PubMedCrossRef
18.
go back to reference Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive. Sleep 19:156–177PubMed Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive. Sleep 19:156–177PubMed
19.
go back to reference Friedman M, Tanyeri H, LaRosa M et al (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109:1901–1907PubMedCrossRef Friedman M, Tanyeri H, LaRosa M et al (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109:1901–1907PubMedCrossRef
20.
go back to reference Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep disordered breathing. Otolaryngol Head Neck Surg 127:13–21PubMedCrossRef Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep disordered breathing. Otolaryngol Head Neck Surg 127:13–21PubMedCrossRef
21.
go back to reference Elshaug AG, Moss JR, Southcott AM, Hiller JE (2007) Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep 30(4):461–467PubMed Elshaug AG, Moss JR, Southcott AM, Hiller JE (2007) Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep 30(4):461–467PubMed
22.
go back to reference Becker HF, Jerrentrup A, Ploch T et al (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107(1):68–73PubMedCrossRef Becker HF, Jerrentrup A, Ploch T et al (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107(1):68–73PubMedCrossRef
23.
go back to reference Elshaug AG, Moss JR, Hiller JE, Maddern GJ (2008) Upper airway surgery should not be first line treatment for obstructive sleep apnoea in adults. BMJ 336(7634):44–45PubMedCrossRef Elshaug AG, Moss JR, Hiller JE, Maddern GJ (2008) Upper airway surgery should not be first line treatment for obstructive sleep apnoea in adults. BMJ 336(7634):44–45PubMedCrossRef
24.
go back to reference Elshaug AG, Moss JR, Southcott AM, Hiller JE (2007) An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnea contraindicated? J Eval Clin Pract 13(1):3–9PubMedCrossRef Elshaug AG, Moss JR, Southcott AM, Hiller JE (2007) An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnea contraindicated? J Eval Clin Pract 13(1):3–9PubMedCrossRef
25.
go back to reference Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–171PubMed Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–171PubMed
26.
go back to reference Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD (2010) Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 33(10):1396–1407PubMed Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD (2010) Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 33(10):1396–1407PubMed
27.
go back to reference Shochat T, Pillar G (2003) Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management. Drugs Aging 20(8):551–560PubMedCrossRef Shochat T, Pillar G (2003) Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management. Drugs Aging 20(8):551–560PubMedCrossRef
28.
go back to reference Soares MCM, Sallum ACR, Gonçalves MTM, Haddad FLM, Gregório LC (2009) Use of Muller’s maneuver in the evaluation of patients with sleep apnea–literature review. Braz J Otorhinolaryngol 75(3):463–466PubMedCrossRef Soares MCM, Sallum ACR, Gonçalves MTM, Haddad FLM, Gregório LC (2009) Use of Muller’s maneuver in the evaluation of patients with sleep apnea–literature review. Braz J Otorhinolaryngol 75(3):463–466PubMedCrossRef
29.
go back to reference Rabelo FAW, Braga A, Küpper DS, Oliveira JAAD, Lopes FM, Mattos PLVDL, Barreto SG, Sander HH, Fernandes RMF, Valera FCP (2010) Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg 142:218–224PubMedCrossRef Rabelo FAW, Braga A, Küpper DS, Oliveira JAAD, Lopes FM, Mattos PLVDL, Barreto SG, Sander HH, Fernandes RMF, Valera FCP (2010) Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg 142:218–224PubMedCrossRef
30.
go back to reference Hessel NS, DeVries N (2003) Role of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients. Eur Arch Otorhinolaryngol 260(2):91–95PubMed Hessel NS, DeVries N (2003) Role of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients. Eur Arch Otorhinolaryngol 260(2):91–95PubMed
31.
go back to reference Miljeteig H, Hoffstein V, Cole P (1992) The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea. Laryngoscope 102:1150–1152PubMedCrossRef Miljeteig H, Hoffstein V, Cole P (1992) The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea. Laryngoscope 102:1150–1152PubMedCrossRef
32.
go back to reference Kohler M, Bloch KE, Stradling JR (2007) The role of the nose in the pathogenesis of obstructive sleep apnoea and snoring. EurRespir J 30(6):1208–1215CrossRef Kohler M, Bloch KE, Stradling JR (2007) The role of the nose in the pathogenesis of obstructive sleep apnoea and snoring. EurRespir J 30(6):1208–1215CrossRef
33.
go back to reference Georgalas C (2011) The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 268(9):1365–1373PubMedCrossRef Georgalas C (2011) The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 268(9):1365–1373PubMedCrossRef
34.
go back to reference Levin BC, Becker GD (1994) Uvulopalatopharyngoplasty for snoring: long-term results. Laryngoscope 104:1150–1152PubMedCrossRef Levin BC, Becker GD (1994) Uvulopalatopharyngoplasty for snoring: long-term results. Laryngoscope 104:1150–1152PubMedCrossRef
35.
go back to reference Koay CB, Freeland AP, Stradling JR (1995) Short-and long-term outcomes of uvulopalatopharyngoplasty for snoring. Clin Otolaryngol 20:45–48PubMedCrossRef Koay CB, Freeland AP, Stradling JR (1995) Short-and long-term outcomes of uvulopalatopharyngoplasty for snoring. Clin Otolaryngol 20:45–48PubMedCrossRef
36.
go back to reference Tomita S, Abreu HF (2000) Avaliação de novo método de uvulopalatofaringoplastia no tratamento do ronco. Arch Otolaryngol 4(2):122 Tomita S, Abreu HF (2000) Avaliação de novo método de uvulopalatofaringoplastia no tratamento do ronco. Arch Otolaryngol 4(2):122
37.
go back to reference Friberg D, Carlsson-Nordlander B, Larsson H, Svanborg E (1995) UPPP for habitual snoring: a 5-year follow-up with respiratory sleep recordings. Laryngoscope 105:519–522PubMedCrossRef Friberg D, Carlsson-Nordlander B, Larsson H, Svanborg E (1995) UPPP for habitual snoring: a 5-year follow-up with respiratory sleep recordings. Laryngoscope 105:519–522PubMedCrossRef
38.
go back to reference Friedman M, Vidyasagar R, Bliznikas D, Joseph N (2005) Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome? Laryngoscope 115(12):2109–2113PubMedCrossRef Friedman M, Vidyasagar R, Bliznikas D, Joseph N (2005) Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome? Laryngoscope 115(12):2109–2113PubMedCrossRef
39.
go back to reference Conway W, Fujita S, Zorick F, Sicklesteel J, Roehrs T, Wittig R, Roth T (1985) Uvulopalatopharyngoplasty. One-year followup. Chest 88:385–387PubMedCrossRef Conway W, Fujita S, Zorick F, Sicklesteel J, Roehrs T, Wittig R, Roth T (1985) Uvulopalatopharyngoplasty. One-year followup. Chest 88:385–387PubMedCrossRef
40.
go back to reference Xiong YP, Yi HL, Yin SK, Meng LL, Tang XL, Guan J, Luo HP, Zhang WT, Chen B (2011) Predictors of surgical outcomes of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome. Otolaryngol Head Neck Surg 145(6):1049–1054PubMedCrossRef Xiong YP, Yi HL, Yin SK, Meng LL, Tang XL, Guan J, Luo HP, Zhang WT, Chen B (2011) Predictors of surgical outcomes of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome. Otolaryngol Head Neck Surg 145(6):1049–1054PubMedCrossRef
41.
go back to reference Lundkvist K, Januszkiewicz A, Friberg D (2009) Uvulopalatopharyngoplasty in 158 OSAS patients failing non-surgical treatment. Acta Otolaryngol 129(11):1280–1286PubMedCrossRef Lundkvist K, Januszkiewicz A, Friberg D (2009) Uvulopalatopharyngoplasty in 158 OSAS patients failing non-surgical treatment. Acta Otolaryngol 129(11):1280–1286PubMedCrossRef
42.
go back to reference Khan A, Ramar K, Maddirala S, Friedman O, Pallanch JF, Olson EJ (2009) Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience. Mayo Clin Proc 84(9):795–800PubMedCrossRef Khan A, Ramar K, Maddirala S, Friedman O, Pallanch JF, Olson EJ (2009) Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience. Mayo Clin Proc 84(9):795–800PubMedCrossRef
43.
go back to reference Janson C, Gislason T, Bengtsson H, Eriksson G, Lindberg E, Lindholm CE, Hultcrantz E, Hetta J, Boman G (1997) Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 123(3):257–262PubMedCrossRef Janson C, Gislason T, Bengtsson H, Eriksson G, Lindberg E, Lindholm CE, Hultcrantz E, Hetta J, Boman G (1997) Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 123(3):257–262PubMedCrossRef
44.
go back to reference Larsson H, Carlsson-Nordlander B, Svanborg E (1994) Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome. Laryngoscope 104(11):1362–1368PubMedCrossRef Larsson H, Carlsson-Nordlander B, Svanborg E (1994) Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome. Laryngoscope 104(11):1362–1368PubMedCrossRef
45.
go back to reference Hultcrantz E, Johansson K, Bengtson H (1999) The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up. J Laryngol Otol 113:542–547PubMedCrossRef Hultcrantz E, Johansson K, Bengtson H (1999) The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up. J Laryngol Otol 113:542–547PubMedCrossRef
46.
go back to reference Lu S, Chang S, Shiao G (1995) Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty. J Laryngol Otol 109:308–312PubMedCrossRef Lu S, Chang S, Shiao G (1995) Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty. J Laryngol Otol 109:308–312PubMedCrossRef
47.
go back to reference Boot H, van Wegen R, Poublon RM (2000) Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Laryngoscope 110:469–475PubMedCrossRef Boot H, van Wegen R, Poublon RM (2000) Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Laryngoscope 110:469–475PubMedCrossRef
48.
go back to reference Tufik S, Martinho FL (2004) Indicação cirúrgica otorrinolaringológica em um ambulatório para pacientes com síndrome da apnéia e hipopnéia obstrutiva do sono. Rev Bras Otorrinolaringol 70(1):46–51CrossRef Tufik S, Martinho FL (2004) Indicação cirúrgica otorrinolaringológica em um ambulatório para pacientes com síndrome da apnéia e hipopnéia obstrutiva do sono. Rev Bras Otorrinolaringol 70(1):46–51CrossRef
Metadata
Title
Is uvulopalatopharyngoplasty still an option for the treatment of obstructive sleep apnea?
Authors
Adriano Braga
Luiz H. Carboni
Tassiana do Lago
Daniel S. Küpper
Alan Eckeli
Fabiana C. P. Valera
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
European Archives of Oto-Rhino-Laryngology / Issue 2/2013
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-012-2042-3

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