Efficacy of uvulopalatopharyngoplasty in unselected patients with mild obstructive sleep apnea

OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is widely used as a first-step procedure for the surgical management of obstructive sleep apnea (OSA) syn drome but best manages obstruction occurring at the level of the oropharynx alone and not the hypopharynx. Previous publications have noted mediocre r esults with use of this procedure in unselected patients with OSA, but less clear is the effectiveness of this procedure in the unselected patient wit h mild OSA (respiratory event index (REI) 5-25). Using objective and subjec tive criteria, we retrospectively analyzed the results of UPPP in patients with mild OSA, METHODS: We examined 37 patients with mild OSA (REI 13.5 +/- 5.1, range 5.6 -23.1) who had been operated on during 1996 with UPPP with or without tonsi llectomy and/or septoplasty, Follow-up polysomnography was obtained in 25 ( 68%) an average of 40.5 weeks after surgery and compared with findings befo re surgery. Subjective assessment of sleepiness was performed with the Slee p-Wake Activity Inventory. RESULTS: Ten patients (40%) had a postoperative reduction in the REI of mom than 50%, comparable with the improvements reported in those with more sev ere apnea, Those who did not have a reduction in REI after surgery actually saw an increase in average REI from 16.6 +/- 5 to 26.7 +/- 18.4. Similarly , subjective assessment of sleepiness with the Sleep-Wake Activity Inventor y showed no statistically significant improvement after surgery. CONCLUSION: Overall, these results indicate that UPPP alone in the unselect ed patient provides little benefit in the management of mild OSA, similar t o findings for more severe OSA, Surgeons must use great care in discerning the level of obstruction in the patient with mild OSA to tailor the appropr iate retropalatal and/or retrolingual procedures and thereby achieve excell ent surgical outcomes.