title: Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system.
abstract: OBJECTIVE
  To evaluate and compare outcomes of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea/hypopnea syndrome (OSAHS) using anatomy- and severity-based staging systems.
  
  
  METHODS
  Prospective design with a retrospective review.
  
  
  METHODS
  A tertiary-care, sleep disorder referral center.
  
  
  METHODS
  In total, 110 patients with OSAHS (105 men, 5 women; mean age, 43 years; apnea-hypopnea index, 44.4 +/- 28.8 events per hour; body mass index, 27.1 +/- 3.3 kg/m2).
  
  
  METHODS
  An anatomy-based staging system (stages I-IV) was used to classify patients with OSAHS by examining tongue-palate position, tonsil size, body mass index, and craniofacial deformities. Patients were also classified as having mild, moderate, moderate-severe, or severe OSAHS based on preoperative apnea-hypopnea index from polysomnography (a severity-based staging system). Surgical success was defined as a 50% or greater reduction in the apnea-hypopnea index and a postoperative apnea-hypopnea index of less than 20 events per hour.
  
  
  METHODS
  UPPP was performed in all patients.
  
  
  RESULTS
  The overall success rate of UPPP was 78%. Success rates for mild (90%), moderate (73%), moderate-severe (81%), and severe (74%) diseases were similar (p = .10). Conversely, success rates for patients with anatomy-based stages I, II, III, and IV were 100%, 96%, 65%, and 20%, respectively; these rates were significantly different (p < .001). Changes in apnea-hypopnea index were significantly correlated with Friedman tongue position (FTP) (r = -0.33, p = .0004) and tonsil size (r = -0.37, p < .0001). The FTP (odds ratio = 0.43, SE = 0.13, p = .005, 95% confidence interval = 0.24-0.78) and tonsil size (odds ratio = 3.13, SE = 1.53, p = .02, 95% confidence interval = 1.20-8.17), but not the severity-based staging (odds ratio = 0.77, SE = 0.18, p = .283, 95% confidence interval = 0.49-1.23), were predictive of surgical success.
  
  
  CONCLUSIONS
  The anatomy-based staging system predicted UPPP outcomes more effectively than did the severity-based staging. The anatomy-based staging system facilitates good case-selection information for counseling patients before UPPP surgery.
authors.affiliation: Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, Taipei, Taiwan. hyli38@adm.cgmh.org.tw
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
authors.forename: Pa-Chun
authors.initials: PC
authors.lastname: Wang
authors.forename: Li-Ang
authors.initials: LA
authors.lastname: Lee
authors.forename: Ning-Hung
authors.initials: NH
authors.lastname: Chen
authors.forename: Tuan-Jen
authors.initials: TJ
authors.lastname: Fang
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000033:anatomy & histology* / Q000601:surgery*; D010614:Pharynx / Q000033:anatomy & histology* / Q000601:surgery*; D017286:Polysomnography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000033:anatomy & histology* / Q000601:surgery*