title: Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience.
abstract: To assess the role of uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea (OSA) using polysomnography (PSG) data within 6 months before and after surgery.
  
  
  
  We analyzed PSG and body mass index (BMI) data from patients with OSA who were 18 years or older and who underwent UPPP between January 1, 1988, and August 31, 2006.
  
  
  
  Sixty-three patients (51 men [81.0%]; mean +/- SD age, 42.1+/-13.9 years; mean +/- SD BMI, 34.9+/-7.2) underwent PSG a mean +/- SD of 50+/-47 days before and 88.5+/-34.0 days after UPPP. Surgical cure was defined as a postoperative apnea-hypopnea index (AHI) of 5 or less. Fifteen patients (24%) achieved a surgical cure. Twenty-one patients (33%) had a postoperative AHI of 10 or less, whereas 32 (51%) achieved a 50% or greater reduction in AHI and/or an AHI of 20 or less. No significant changes were noted in BMI before and 6 months after UPPP. Patients who attained an AHI of 5 or less were younger (mean +/- SD age, 35.9+/-13.1 vs 44+/-13.7 years; P=.05), had lower BMIs (mean +/- SD, 30.8+/-6.5 vs 34.6+/-6.6; P=.05), and had less severe OSA (mean +/- SD AHI, 38.1+/-33.6 vs 69.6+/-32.8; P=.004). Of the 48 patients (76%) with a post-UPPP AHI greater than 5, 35 (56%) received continuous positive airway pressure, with a mean reduction in pressure of 1.4 cm H(2)O (95% confidence interval, -0.4 to -2.4 cm H(2)O).
  
  
  
  Independent of changes in BMI, in our retrospective analysis, UPPP achieved an AHI of 5 or less in 24% and an AHI of 10 or less in 33% of patients with OSA who underwent PSG 6 months before and after surgery. In those with residual OSA who received continuous positive airway pressure, the required pressure setting decreased by 1.4 cm H(2)O.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Center for Sleep Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA. khana@ohsu.edu
authors.forename: Akram
authors.initials: A
authors.lastname: Khan
authors.forename: Kannan
authors.initials: K
authors.lastname: Ramar
authors.forename: Supriya
authors.initials: S
authors.lastname: Maddirala
authors.forename: Oren
authors.initials: O
authors.lastname: Friedman
authors.forename: John F
authors.initials: JF
authors.lastname: Pallanch
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Olson
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010159:Palate / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014609:Uvula / Q000601:surgery