Simple predictors of uvulopalatopharyngoplasty outcome in the treatment ofobstructive sleep apnea

Study objective: Our objective was to determine whether baseline polysomnog raphy, cephalometry, and anthropometry data could predict uvulopalatopharyn goplasty (UPPP) success or failure. Design: We retrospectively reviewed polysomnography, cephalometry, and anth ropometry data from patients who underwent UPPP for obstructive sleep apnea (OSA). Setting: A university medical center. Patients: OSA was diagnosed by polysomnography in 46 patients who underwent UPPP surgery for their sleep disorder. Interventions: UPPP surgery with/or without tonsillectomy. Measurements and results: The mean patient age was 43 years, and the mean b ody mass index was 32.5 kg/m(2). The mean presurgical apnea-hypopnea index (AHI) was 45, and the mean baseline nadir oxygen saturation was 81%. Succes sful surgery was defined as a reduction in AHI to < 10 or to < 20 with a 50 % reduction from the patient's baseline AHI. Of the 46 patients, 16 were su ccessfully treated and 30 did not respond to surgical treatment. A mandibul ar-hyoid distance (MP-H) > 20 mm was found to be significantly (p = 0.05) p redictive of failure of UPPP. When stepwise regression analysis was perform ed utilizing postsurgical AHI as the dependent variable and presurgical AHI , age, body mass index, baseline nadir O-2 saturation, and five cephalometr ic measurements as independent variables, MP-H distance significantly (r = 0.524; p = 0.01) correlated positively with postsurgical AHI, The distance between the superior point of a line-constructed plane of the sphenoidale ( parallel to Frankfort horizontal) and a point at the intersection of the pa latal plane perpendicular to the hyoid correlated negatively with postsurgi cal AHI (r = 0.586; p = 0.05). By creating a logistic model of this data, a n MP-H distance < 21 mm, an angle created by point A to the nasion to point B < 3 degrees, and the presence of a baseline AHI < 38 enhanced the predic tability of UPPP success. Conclusions: The presence of a baseline AHI < 38 and an MP-H less than or e qual to 20 mm, and the absence of retrognathia are predictors of improvemen t after UPPP, Based on these findings, we would advocate the continued eval uation of cephalometric measurements and careful consideration of surgical treatment options for OSA.