title: Laser-assisted uvulopalatoplasty and tonsillectomy for the management of obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  Laser-assisted uvulopalatoplasty (LAUP) is a widely accepted procedure for the management of snoring, but its role in the treatment of obstructive sleep apnea syndrome is currently unclear. The objective of the study was to evaluate the role of LAUP in treating moderate and severe obstructive sleep apnea syndrome.
  
  
  METHODS
  Retrospective review of a surgical treatment protocol for obstructive sleep apnea syndrome.
  
  
  METHODS
  Between October 1993 and January 1999, 80 patients with moderate or severe obstructive sleep apnea syndrome and a significant component of retropalatal obstruction were treated with surgery at the Department of Otolaryngology at Northwestern University Medical School (Chicago, IL). Surgery consisted of LAUP with tonsillectomy (if tonsils were present) with the patient under general anesthesia or LAUP alone with local anesthesia (if the tonsils were absent). No patients received traditional uvulopalatopharyngoplasty. Sixty-four of the 80 patients underwent both preoperative and postoperative polysomnograms. Surgical "response" was defined as a 50% decrease in the apnea-hypopnea index (AHI) (the total number of apneic and hypopneic events per hour of sleep); surgical "cure" was defined as a 50% decrease in AHI and a final AHI of less than 20.
  
  
  RESULTS
  The surgical response rate was 59% (38 of 64 patients), and the surgical cure rate was 39% (25 of 64 patients). Twelve patients (18.8%) had a higher AHI after surgery. The AHI (mean +/- SD) changed significantly from 51.4 +/- 30.9 preoperatively to 26.3 +/- 20.8 on postoperative polysomnogram (P = 7.0 x 10-9). Laser-assisted uvulopalatoplasty alone was performed in 33 patients with a response rate of 61% and a cure rate of 42%. Laser-assisted uvulopalatoplasty with tonsillectomy was performed in 31 patients with a response rate of 58% and a cure rate of 35%. The overall incidence of nasopharyngeal insufficiency was 0%.
  
  
  CONCLUSIONS
  The results of the study suggested that LAUP with adjunctive tonsillectomy is an effective treatment for patients with obstructive sleep apnea syndrome and retropalatal obstruction with a lower complication rate than standard surgical therapy (uvulopalatopharyngoplasty).
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Northwestern University Medical School, University Searle Building 12-561, 303 East Chicago Avenue, Chicago, IL 60611-3008, USA. r-kern@northwestern.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kern
authors.forename: David I
authors.initials: DI
authors.lastname: Kutler
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Reid
authors.forename: David B
authors.initials: DB
authors.lastname: Conley
authors.forename: Garrett D
authors.initials: GD
authors.lastname: Herzon
authors.forename: Phyllis
authors.initials: P
authors.lastname: Zee
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D010160:Palate, Soft / Q000601:surgery*; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*; D014068:Tonsillectomy; D014609:Uvula / Q000601:surgery*