Tuesday, October 13, 2009

Sleep Apnea Surgery: Is UPPP for You?

Are some people with obstructive sleep apnea more likely to benefit from surgery than others?

new study involved 63 people with OSA. They had an average age of 42 years, and 81 percent were men. Their average body mass index was 35; a BMI of 30 or higher is considered “obese.”

Each person underwent “uvulopalatopharyngoplasty.” UPPP involves the removal of soft tissue from the throat; this tissue can collapse and block the airway during sleep. The soft palate is trimmed down in size. The tonsils and uvula may also be removed.

The effectiveness of UPPP was measured after an average of about three months; participants were monitored during an
overnight sleep study.

Results show that the surgery eliminated OSA in only 24 percent of participants. These people were younger and less obese. They had an average age of 36 years and an average BMI of 31.

They also had less severe sleep apnea. Before surgery they had an average apnea-hypopnea index of 38 breathing pauses per hour of sleep. The average pre-treatment AHI was almost 70 in people who still had sleep apnea after surgery.

“This latest research helps us identify the patients who are the best candidates for surgery,” lead author Dr. Akram Khan said in a
press release.

The AASM reports that
CPAP therapy is the treatment of choice for all severity levels of OSA. A surgical procedure is an alternative treatment option for some people with sleep apnea. It may be required to correct a physical abnormality; it also may be performed if you are unable to have success with CPAP or an oral appliance.

There are a variety of surgeries that can help correct a specific problem. Targeted areas include the throat, tonsils, jaw and nose. Surgery may not cure OSA; you may need to continue with another treatment such as CPAP. Positive results also may not be permanent; symptoms may reappear at a later time after surgery.

Get help for sleep apnea at an AASM-accredited sleep center near you.

1 comment:

Steven Y. Park, MD said...

What this article doesn't mention is that the soft palate is usually not the only area of narrowing and collapse. Usually, the tongue is also involved, as well as the nose. You have to address the entire upper airway appropriately to the best results. Previous multi-level surgery studies have shown up to 75 to 80% success rates. A maxillo-mandibular advancement procedure, where the midface and the jaw is pulled forward, has over 90% success rates. There are very few patients that will benefit from UPPP alone. It's possible to select these patients using various measures (including the Friedman criteria), but most people will not be good candidates for the UPPP by itself.

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