title: Combination surgical and mechanical therapy for refractory cases of obstructive sleep apnea.
abstract: OBJECTIVE
  Our purpose was to investigate the effects of surgical alteration of the soft palate by laser-assisted uvulopalatoplasty (LAUP) on the effectiveness of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea. Specifically, is there any change in effective CPAP pressure after LAUP?
  
  
  METHODS
  Ten patients from a group of LAUP candidates who either failed LAUP treatment as measured by pre- and postpolysomnography or were unable to tolerate CPAP were prospectively evaluated.
  
  
  METHODS
  Fifty patients were referred to an otolaryngologist for evaluation and treatment of obstructive sleep apnea. Forty-three had LAUP surgery. Five patients had failed LAUP therapy and another five were unable to tolerate CPAP prior to LAUP.
  
  
  METHODS
  Polysomnography was used to evaluate patients pre- and postoperatively. Polysomnography with CPAP titration was then used to compare the effects of LAUP in combination with CPAP.
  
  
  RESULTS
  The average, effective CPAP decreased by 4.8 cm H2O after LAUP. In patients who failed LAUP therapy, CPAP was still found to be effective.
authors.affiliation: Department of Surgery, Division of Otolaryngology, University of Alberta, Edmonton, Alberta.
authors.forename: Robert
authors.initials: R
authors.lastname: Seemann
authors.forename: John C
authors.initials: JC
authors.lastname: DiToppa
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Holm
authors.forename: John
authors.initials: J
authors.lastname: Hanson
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome