Skip to main content
Log in

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

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Guilleminault C, Tilkian A, Dement WC (1976) The sleep apnea community-based study. Sleep heart health study. JAMA syndromes. Annu Rev Med 27:465–484

    Article  PubMed  CAS  Google Scholar 

  2. 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

    Google Scholar 

  3. StrolloJr PJ, Rogers RM (1996) Current concepts: obstructive sleep apnea. NEngl J Med 334:99–104

    Article  CAS  Google Scholar 

  4. 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. Badr MS (1998) Pathophysiology of upper airway obstruction during sleep. Clin Chest Med 19(1):21–32

    Article  PubMed  CAS  Google Scholar 

  6. 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):435–440

    PubMed  Google Scholar 

  7. Blumen MB, Dahan S, Fleury B et al (2002) Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea. Laryngoscope 112(11):2086–2092

    Article  PubMed  Google Scholar 

  8. Verse T, Maurer JT, Pirsig W (2002) Effect of nasal surgery on sleep related breathing disorders. Laryngoscope 112(1):64–68

    Article  PubMed  Google Scholar 

  9. Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively surgical patients. Otolaryngol Head Neck Surg 108(2):117–125

    PubMed  CAS  Google Scholar 

  10. 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

    Google Scholar 

  11. Gooday RH, Percious DS, Morrison AD et al (2001) Obstructive sleep apnea syndrome: diagnosis and management. J Am Dent Assoc 67(11):652–658

    Google Scholar 

  12. Fujita S, Conway W, Zorick F et al (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89:923–934

    PubMed  CAS  Google Scholar 

  13. 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):156–177

    PubMed  CAS  Google Scholar 

  14. Friedman et al (2004) Staging of obstructive sleep apnea/hypopnea syndrome. Laryngoscope 114(3):454–459

    Article  PubMed  Google Scholar 

  15. Powell NB, Guilleminault C, Riley RW (1994) Principles and practice of sleep medicine. W.B. Saunders Company, Philadelphia, pp 706–721

    Google Scholar 

  16. Reimão R, Joo SH (2000) Mortalidade da apnéia obstrutiva do sono. Rev Assoc Med Bras 46(1):52–56

    Article  PubMed  Google Scholar 

  17. 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 105:155–159

    Article  PubMed  CAS  Google Scholar 

  18. Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive. Sleep 19:156–177

    PubMed  CAS  Google Scholar 

  19. Friedman M, Tanyeri H, LaRosa M et al (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109:1901–1907

    Article  PubMed  CAS  Google Scholar 

  20. Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep disordered breathing. Otolaryngol Head Neck Surg 127:13–21

    Article  PubMed  Google Scholar 

  21. 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):461–467

    PubMed  Google Scholar 

  22. 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):68–73

    Article  PubMed  Google Scholar 

  23. 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):44–45

    Article  PubMed  Google Scholar 

  24. 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):3–9

    Article  PubMed  Google Scholar 

  25. 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):157–171

    PubMed  Google Scholar 

  26. 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):1396–1407

    PubMed  Google Scholar 

  27. Shochat T, Pillar G (2003) Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management. Drugs Aging 20(8):551–560

    Article  PubMed  Google Scholar 

  28. 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):463–466

    Article  PubMed  Google Scholar 

  29. 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 142:218–224

    Article  PubMed  Google Scholar 

  30. 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):91–95

    PubMed  Google Scholar 

  31. Miljeteig H, Hoffstein V, Cole P (1992) The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea. Laryngoscope 102:1150–1152

    Article  PubMed  CAS  Google Scholar 

  32. 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):1208–1215

    Article  CAS  Google Scholar 

  33. Georgalas C (2011) The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 268(9):1365–1373

    Article  PubMed  Google Scholar 

  34. Levin BC, Becker GD (1994) Uvulopalatopharyngoplasty for snoring: long-term results. Laryngoscope 104:1150–1152

    Article  PubMed  CAS  Google Scholar 

  35. Koay CB, Freeland AP, Stradling JR (1995) Short-and long-term outcomes of uvulopalatopharyngoplasty for snoring. Clin Otolaryngol 20:45–48

    Article  PubMed  CAS  Google Scholar 

  36. Tomita S, Abreu HF (2000) Avaliação de novo método de uvulopalatofaringoplastia no tratamento do ronco. Arch Otolaryngol 4(2):122

    Google Scholar 

  37. Friberg D, Carlsson-Nordlander B, Larsson H, Svanborg E (1995) UPPP for habitual snoring: a 5-year follow-up with respiratory sleep recordings. Laryngoscope 105:519–522

    Article  PubMed  CAS  Google Scholar 

  38. Friedman M, Vidyasagar R, Bliznikas D, Joseph N (2005) Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome? Laryngoscope 115(12):2109–2113

    Article  PubMed  Google Scholar 

  39. Conway W, Fujita S, Zorick F, Sicklesteel J, Roehrs T, Wittig R, Roth T (1985) Uvulopalatopharyngoplasty. One-year followup. Chest 88:385–387

    Article  PubMed  CAS  Google Scholar 

  40. 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):1049–1054

    Article  PubMed  Google Scholar 

  41. Lundkvist K, Januszkiewicz A, Friberg D (2009) Uvulopalatopharyngoplasty in 158 OSAS patients failing non-surgical treatment. Acta Otolaryngol 129(11):1280–1286

    Article  PubMed  Google Scholar 

  42. 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):795–800

    Article  PubMed  Google Scholar 

  43. 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):257–262

    Article  PubMed  CAS  Google Scholar 

  44. 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):1362–1368

    Article  PubMed  CAS  Google Scholar 

  45. 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 113:542–547

    Article  PubMed  CAS  Google Scholar 

  46. 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 109:308–312

    Article  PubMed  CAS  Google Scholar 

  47. Boot H, van Wegen R, Poublon RM (2000) Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Laryngoscope 110:469–475

    Article  PubMed  CAS  Google Scholar 

  48. 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):46–51

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fabiana C. P. Valera.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Braga, A., Carboni, L.H., do Lago, T. et al. Is uvulopalatopharyngoplasty still an option for the treatment of obstructive sleep apnea?. Eur Arch Otorhinolaryngol 270, 549–554 (2013). https://doi.org/10.1007/s00405-012-2042-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-012-2042-3

Keywords

Navigation