DYNAMIC PHARYNGOSCOPY IN PREDICTING OUTCOME OF UVULOPALATOPHARYNGOPLASTY FOR MODERATE AND SEVERE OBSTRUCTIVE SLEEP-APNEA

Study objective: We sought to determine whether preoperative fiberopti c pharyngoscopy (FOP) with Muller's maneuver (dynamic FOP) could be us ed to establish a subgroup of obstructive sleep apnea (OSA) patients w ith better outcome after uvulopalatopharyngoplasty (UPPP). Design: Ret rospective review of an observational cohort. Setting: Tertiary care r eferral center. Patients: Twenty-nine patients who underwent UPPP and nasopharyngeal surgery by one surgeon. Intervention: The patients were divided into two groups based on the findings of preoperative dynamic FOP: group 1 (11 patients) had collapse of the velopharynx and the ba se of the tongue-epiglottis-hypopharynx (TEH) complex and group 2 (18 patients) had velopharyngeal collapse only. Measurements and results: Surgical success was defined using a conventional definition (>50% red uction in the apnea-plus-hypopnea index [OAHI]), and a criterion for c ure (>90% reduction in OAHI and postoperative OAHI <15). Both groups h ad a significant improvement in their OAHI. The success rate was signi ficantly higher in patients with velopharyngeal collapse only compared with patients with additional collapse of the TEH complex (78 vs 36% with the conventional definition, and 50 vs 9% using the definition fo r cure, respectively). Predictive value of dynamic FOP in predicting c ure failure when collapse of the TEH complex was present was 91%. Conc lusions: Dynamic FOP may help establish a subgroup of OSA patients wit h greater likelihood of successful UPPP. The high negative predictive value of dynamic FOP when a criterion for cure is used suggests that t his maneuver could best be used to exclude patients with TEH complex c ollapse from UPPP.