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Abstract

Objective:

Uvulopalatopharyngoplasty (UPPP) success rates in patients classified with Friedman stage 3 is reported as 8%. Surgical failure may result from persistent obstruction at the palate, which may be addressed by pharyngoplasty with palatal advancement (PA). The effectiveness of PA versus UPPP was evaluated by using polysomnographic outcomes in a retrospective cohort of patients classified with Friedman stage 3.

Methods:

Surgical records were reviewed for PA (n = 47) and UPPP (n = 124). Clinical records were reviewed and reclassified by Friedman stage. Respiratory data were collected from overnight polysomnography. Statistical analysis was conducted of continuous variables (ANOVA), categorical variables (χ 2 ), and adjusted odds ratios by using logistic regression.

Results:

PA (n = 30) and UPPP (n = 44) did not differ in baseline apnea hypopnea index (AHI), age, or BMI. Both PA (48.3 ± 24.6 to 19.8 ± 16.8 events per hour, P < 0.000) and UPPP (47.9 ± 30.0 to 30.9 ± 24.2 events per hour, P < 0.000) improved with surgery. In the PA group, final AHI was lower (17.1 ± 30.1 versus 28.5 ± 25.6, P < 0.04) and postoperative change was greater (30.9 ± 24.2 versus 19.8 ± 16.8, P < 0.02). For patients with Friedman stage 3, odds ratio of having an AHI of <20 events per hour and a greater than 50% reduction with PA compared with UPPP was 3.80 (95% CI, 1.41-10.29, P < 0.013). Adjusted for age, body mass index, preoperative apnea severity, and tongue-base surgery, OR was 5.77 (95% CI of 1.80-17.98).

Conclusions:

Polysomnographic outcomes using AHI support the use of palatopharyngoplasty using palatal advancement as an effective treatment of obstructive sleep apnea. PA may offer benefit over UPPP alone in patients classified with Friedman stage 3.

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References

1 Fujita

Conway

Zorick

Evaluation of the effectiveness of uvulopalatopharyngoplasty.

Laryngoscope 1985;95:70–4.

2 Maisel

Antonelli

Iber

Uvulopalatopharyngoplasty for obstructive sleep apnea: a community's experience.

Laryngoscope 1992;102:604–7.

Cahali

MB.

Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome.

Laryngoscope 2003;113:1961–8.

4 Sher

Thorpy

Shprintzen

Predictive value of Muller maneuver in selection of patients for uvulopalatopharyngoplasty.

Laryngoscope 1985;95:1483–7.

Friedman

Ibrahim

Bass

Clinical staging for sleep-disordered breathing.

Otolaryngol Head Neck Surg 2002;127:13–21.

Woodson

Wooten

MR.

Manometric and endoscopic localization of airway obstruction following uvulopalatopharyngoplasty.

Otolaryngol Head Neck Surg 1994;111:38–43.

Shepard

Thawley

SE.

Localization of upper airway collapse during sleep in patients with obstructive sleep apnea.

Am Rev Respir Dis 1990;141:1350–5.

8 Schwartz

Schubert

Rothman

Effect of uvulopalato-pharyngoplasty on upper airway collapsibility in obstructive sleep apnea.

Am Rev Respir Dis 1992;145:527–32.

9 Isono

Shimada

Tanaka

Effects of uvulopalatopharyngoplasty on collapsibility of the retropalatal airway in patients with obstructive sleep apnea.

Laryngoscope 2003;113:362–7.

10.

Caballero

Alvarez-Sala

Garcia-Rio

CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome. Chest 1998;113:111–6.

11.

Woodson

BT.

Retropalatal airway characteristics in UPPP compared to transpalatal advancement pharyngoplasty.

Laryngoscope 1997;107: 735–40.

12.

Woodson

Toohill

RJ.

Transpalatal advancement pharyngoplasty for obstructive sleep apnea.

Laryngoscope 1993;103:269–76.

13.

Woodson

BT.

Acute effects of palatopharyngoplasty on airway collapsibility.

Otolaryngol Head Neck Surg 1999;121:82–6.

14.

14 Bar

Pillar

Dvir

Evaluation of a portable device based on arterial peripheral tonometry (PAT) for unattended home sleep studies.

Chest 2003;123:695–703.

15.

15 Redline

Tosteson

Boucher

, Measurement of sleep-related breathing disturbances in epidemiologic studies. Chest 1991; 100:1281–6.

16.

16 Wittig

Fujita

Fortier

Results of uvulopalatopharyngoplasty (UPPP) in patients with both oropharyngeal and hypopharyngeal collapse on Mueller's maneuver.

Sleep Res 1988;17:269.

17.

17 Powell

Riley

Guilleminault

A reversible uvulopalatal flap for snoring and sleep apnea syndrome.

Sleep 1996;19:593–9.

18.

Ikamatsu

Palatopharyngoplasty and partial uvulectomy method of Ikematsu: a 30 year clinical study of snoring. In: Fairbanks

DNL

Fujita

Ikematsu

, , editors. Snoring and sleep apnea, 1st ed. New York: Rivlin Press; 1987. p. 130–134.

19.

Fairbanks

DNF.

Cold surgical instrument uvulectomy and uvulopalatoplasty. In: Fairbanks

DNL

Fujita

Ikematsu

, , editors. Snoring and sleep apnea, 3rd ed. New York: Rivlin Press; 2003. p. 131–135.

20.

Homer

Lemeshow

Applied logistic regression. New York: Wiley, 1989.

21.

21 Neter

Kutner

Nachtsheim

, Applied linear statistical models. New York: McGraw-Hill, 1996.

22.

22 SAS Software: usage and reference. Version 8. Cary, NC: SAS Institute Inc.; 1997.

23.

23 Sher

Thorpy

Shprintzen

Predictive value of Muller maneuver in selection of patients for uvulopalatopharyngoplasty.

Laryngoscope 1985;95:1483–7.

24.

24 Dempsy

Skatrud

Jacques

Anatomical determinates of sleep disordered breathing across the spectrum of clinical and non-clinical subjects.

Chest 2002;122:40–51.

Transpalatal Advancement Pharyngoplasty Outcomes Compared With Uvulopalatopharygoplasty

Abstract

Objective:

Methods:

Results:

Conclusions:

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References