Uvulopalatopharyngoplasty may help those with obstructive sleep apnea

A procedure known as uvulopalatopharyngoplasty (UPPP) may help some patients improve or even eliminate their obstructive sleep apnea (OSA), according to a new study.

The research, presented at CHEST 2007, the 73rd annual international scientific assembly of the American College of Chest Physicians (ACCP), says the procedure, which removes excess tissue in the throat or mouth to widen the airway, can reduce the amount of treatment required by patients with OSA. In addition, researchers say UPPP also can eliminate OSA completely in some patients.

“Continuous positive airway pressure, or CPAP, is a well-established treatment for sleep apnea,” said lead study author Akram Khan, MD, Assistant Professor, University of Florida Jacksonville, “and while most patients tolerate it well, some are unable to tolerate it or don't want to, and those patients need alternative means of treatment.”

To determine if UPPP provided improvement in sleep parameters, Dr. Khan and his colleagues from the Mayo Clinic, Rochester, MN, evaluated the success of the procedure in 63 patients aged 18-80, with OSA, over a 7-year period. All patients underwent UPPP and were assessed with polysomnography within a 6-month period, pre-procedure and post-procedure.

Results showed that UPPP eliminated OSA in approximately one quarter to one-third of patients, depending on the definition of success. Of those who experienced residual OSA and returned to CPAP use, the required CPAP setting was modestly lower. In addition, researchers reported that UPPP also reduced the mean apnea-hyponea index in patients.

“The apnea-hyponea index basically tells us the number of times a patient with sleep apnea quits breathing per hour,” Dr. Khan explained. “We found that the surgical procedure reduced patients' apenic (nonbreathing) episodes by more than half.” According to Dr. Khan, UPPP provided an improvement in oxygen levels and other parameters of sleep, as well.

First described in 1981, UPPP has been used widely with varying results. Though researchers are unclear on what characteristics make up the ideal UPPP candidate, they suggest that patients with mild OSA, who are relatively young, lean, and healthy, may have the best results with this procedure. Researchers also believe that a decrease in CPAP requirements would likely improve compliance in patients who don't have their OSA completely resolved.

“Obstructive sleep apnea increases the risk of other illnesses, such as heart disease, high blood pressure, and stroke, among others,” said Alvin V. Thomas, Jr., MD, FCCP, President of the American College of Chest Physicians. “Patients and physicians need to work together to recognize the signs of sleep apnea and to identify which method of treatment is most suitable.”