Unpredictable results of laser assisted uvulopalatoplasty in the treatmentof obstructive sleep apnoea

Background-Laser assisted uvulopalatoplasty (LAUP) is increasingly offered for the treatment of obstructive sleep apnoea (OSA), although there is a la ck of objective data to support its indications and efficacy. A study was u ndertaken to determine the treatment response to LAUP. Methods-Overnight polysomnography was performed before and at least three m onths after surgery in 44 consecutive patients with symptomatic mild to mod erate OSA (apnoea + hypopnoea index (AHI) >10/h), Pharyngeal dimensions wer e measured by videoendoscopy (n = 11) and disease-specific quality of life, sleepiness and snoring frequency (n = 16) before and after surgery were de termined in subgroups of patients. LAUP was performed under local anaesthes ia as a one stage resection of the uvula and soft palate by one of two expe rienced otolaryngologists. Results-Twelve patients (27%) had a good response (AHI less than or equal t o 10/h after LAUP); four (9%) had a partial response (AHI less than or equa l to 50% of pre-LAUP value); 15 (34%) had a poor response (AHI >50% of pre- LAUP value); and 13 (30%) patients were worse (AHI >100% of pre-LAUP value) . The velopharyngeal cross sectional area and anteroposterior diameter incr eased following LAUP (p<0.05). Quality of life indices improved significant ly in all domains and sleepiness decreased. The snoring index did not decre ase significantly. No preoperative anthropometric or videoendoscopic measur es were predictive of a good response to LAUP. Patients who were worse afte r LAUP had milder baseline apnoea severity than those in the other response groups. Conclusions-The treatment response to LAUP is variable and unpredictable, a nd only a few patients achieve a satisfactory response. There appears to be no relationship between subjective and objective measures of treatment eff icacy.