THE EFFICACY OF ORAL APPLIANCES IN THE TREATMENT OF PERSISTENT SLEEP-APNEA AFTER UVULOPALATOPHARYNGOPLASTY

Twenty-four patients who failed uvulopalatopharyngoplasty (UPPP) for o bstructive sleep apnea (OSA) had an adjustable oral (Herbst) appliance made to treat the persistent apnea. Six patients discontinued the dev ice prior to sleep evaluation. Eighteen patients had polysomnographic evaluations at baseline, post-UPPP, and with the Herbst appliance in p lace. The apnea-hypopnea index baseline (AHI) and arterial oxygen satu ration (SaO(2)) nadir were 42.3+/-6.1 and 83.6+/-1.8%, respectively. T here was no significant change in either parameter with surgery. With the oral appliance, the AHI fell to 15.3+/-4.4 (p less than or equal t o 0.01) and the SaO(2) nadir increased to 87.9+/-1.2% (p less than or equal to 0.05). Ten of the patients had control of the OSA with the He rbst appliance with a fall in the AHI to < 10. There were, in addition , two partial responders as defined by an AHI of <20 and a >50% fall i n AHI compared with baseline and post-UPPP values. All but one of the responders and partial responders had complete resolution of subjectiv e symptoms of daytime sleepiness with the appliance. An adjustable ora l appliance appears to be an effective mode of therapy to control OSA after an unsuccessful UPPP.