CAN OBSTRUCTIVE SLEEP-APNEA BE A COMPLICATION OF UVULOPALATOPHARYNGOPLASTY

Polysomnography is currently used for diagnosis, evaluation and select ion of therapy in patients with obstructive sleep apnoea (OSA), but cl inically successful uvulopalatopharyngoplasty (UPPP) is not necessaril y reflected by post-operative improvement of polysomnographic recordin gs. Post-operative polysomnography may suggest deterioration of pre-ex isting OSA or, in snorers, de-novo precipitation of OSA. Thus, if poly somnography is a reliable indicator of OSA, then OSA may be a post-ope rative risk of UPPP. The aims of our study were: (i) to assess the pos sible deleterious effect of UPPP on sleep patterns; (ii) to further de fine the role of cardioisotope scanning in the evaluation of OSA; (iii ) to assess the reliability of polysomnography given the clinical and cardioisotope scan findings. Symptoms, polysomnography and radionuclid e ventriculography were prospectively compared pre- and post-operative ly in 41 patients undergoing UPPP. In 12 patients (29 per cent), there were disparate results between pre- or post-operative polysomnography and the clinical and/or radionuclide ventriculography, as follows: In four of 16 patients with abnormal pre-operative ventricular performan ce, there was pre-operative symptomatology of severe OSA and a bedmate 's reports of apnoeic episodes. This was in contrast to normal or near normal sleep apnoea recordings. In eight patients, post-operative imp rovement of symptoms was reported, despite deterioration of post-opera tive polysomnographic recordings. In these patients the post-operative improvement of symptoms was also reflected by improved ventricular pe rformance. Worsening of ventricular performance was not demonstrated i n any patient. In conclusion, UPPP does not induce OSA. Polysomnograph y may underestimate or even misdiagnose cases of OSA. The diagnostic i mportance of patient symptomatology should be stressed particularly in those patients with only mildly abnormal or even completely normal sl eep studies. A combination of polysomnographic and cardiovascular eval uation in patients with symptomatology consistent with OSA is recommen ded.