title: Does the length of uvula affect the palatal implant outcome in the management of habitual snoring?
abstract: OBJECTIVE
  To evaluate the impact of the uvular length on the efficacy of palatal implants in primary snoring.
  
  
  METHODS
  Prospective case series, tertiary hospital, snoring and respiratory sleep disorders center.
  
  
  METHODS
  Forty subjects with inserted palatal implants and diagnoses of primary snoring were included. All met the inclusion criteria of age >18 years, body mass index <30, apnea-hypopnea index <5, tonsil grade <3, soft-palate length >25 mm, and Friedman tongue position <3 following clinical, endoscopic, and polysomnographic evaluation. Epworth sleepiness scale (ESS) and the snoring-intensity visual analogue scale (VAS) were recorded before and 9 months after the implant. Four subjects with extruded implants were excluded; the remaining 36 subjects were divided into two groups, Group I and Group II, with uvular lengths of ≤15 mm and >15 mm, respectively. The study assessed and compared subjective outcome measures including the partner's satisfaction (PS), partner's reported improvement (PRI), 50% VAS and ESS reduction, and subjective success (SS) defined as 50% VAS reduction. The Student t test, χ(2) test, and logistic regression models were used for statistical evaluation.
  
  
  RESULTS
  SS (50% VAS reduction), PS, PRI, and 50% ESS reduction were significantly higher in Group I (P < .001, P = .0257, P = .027, P < .001). The overall SS, PRI, PS, and 50% ESS reduction were 33%, 78%, 50%, and 50%, respectively. The uvular length was found to be the determinant factor of SS (P = .005; odds ratio = 0.75), PRI (P = .039; odds ratio = 0.83), and 50% ESS reduction (P = .038; odds ratio: 0.84) following implant insertion through stepwise logistic regression analysis.
  
  
  CONCLUSIONS
  Excess uvular length (>15 mm) is an important anatomic feature decreasing the efficacy of palatal implants in snoring, and additional measures, such as uvulectomy, should be considered simultaneously for better outcomes (level 4).
authors.affiliation: Second Clinic of Otolaryngology, Head and Neck Surgery, Ministry of Health Istanbul Training and Research Hospital, Istanbul, Turkey. meltemakpinar@hotmail.com
authors.forename: Meltem Esen
authors.initials: ME
authors.lastname: Akpinar
authors.forename: Ozgur
authors.initials: O
authors.lastname: Yigit
authors.forename: Ismail
authors.initials: I
authors.lastname: Kocak
authors.forename: Aytug
authors.initials: A
authors.lastname: Altundag
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D019736:Prostheses and Implants; D012913:Snoring / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000033:anatomy & histology*; D055815:Young Adult