Efficacy of endoscopic static pressure area assessment of the passive pharynx in predicting uvulopalatopharyngoplasty outcomes

Objectives/Hypothesis: Although uvulopalatopharyngoplasty (UPPP) is an attr active surgical treatment for obstructive sleep apnea (OSA), the unpredicta ble outcome limits application of the procedure. Since UPPP corrects only r etropalatal airway (RP) patency, we hypothesized that response to UPPP is d etermined by collapsibility of the retroglossal airway (RG), where UPPP doe s not correct. Methods: We estimated closing pressure (P-close) for each ph aryngeal segment by endoscopically obtaining the static pressure/area relat ionship of the passive pharynx in completely paralyzed and anesthetized pat ients with sleep-disordered breathing (n = 41) before UPPP, Preferable resp onse to UPPP was defined as the number of oxygen dips (ODI), obtained by no cturnal oximetry, less than 10 h(-1) after UPPP, Results: Patients with neg ative P-close at RG responded to UPPP significantly better than those with positive P-close at RG (22/30 [73%] vs. 3/11 [27%], P <.05), ODI after UPPP was significantly correlated with age, P-close at RP, and P-close at RG, C onclusions: Endoscopic assessment of anatomic abnormality of the pharynx in paralyzed patients with sleep-disordered breathing under general anesthesi a has clinical value for the improvement of UPPP outcome.