title: Theoretical approach towards increasing effectiveness of palatal surgery in obstructive sleep apnea: role for concomitant positional therapy?
abstract: OBJECTIVE
  The aims of this study are to evaluate the effect of palatal surgery (uvulopalatopharyngoplasty (UPPP) or Z-palatoplasty (ZPP)) with or without (+/-) concomitant radiofrequent ablation of the base of the tongue (RFTB) on body position-specific apnea-hypopnea index (AHI) values in patients with obstructive sleep apnea (OSA) and to compare this treatment outcome to the theoretical effect of (addition of) positional therapy (PT).
  
  
  METHODS
  Retrospective analysis of pre- and posttreatment polysomnographies in 139 patients who had undergone UPPP/ZPP +/- RFTB was performed. Hypothetical evaluation of the effects of (addition of) ideal PT on AHI in positional OSA (POSA) patients was carried out.
  
  
  RESULTS
  Median AHI significantly decreased from 18.0 to 11.2 (p < 0.001). Median AHI in all separate positions decreased significantly as well. Sixty-eight patients suffered from POSA and showed a significant decrease in median AHI from 15.5 to 11.5 (p = 0.002). In the 71 non-positional OSA (NPOSA) patients, the significant AHI decrease was more outspoken, from 23.0 to 11.0 (p < 0.001). Our hypothetical model to treat POSA patients with an ideal PT (as monotherapy or in addition to surgery) resulted in a significant median AHI decrease from 18.0 to 4.5 (p < 0.0001).
  
  
  CONCLUSIONS
  UPPP/ZPP +/- RFTB significantly reduces AHI and all body position-specific AHI values. This reduction is significantly higher in NPOSA than in POSA patients. When considering UPPP/ZPP +/- RFTB, the effect of body position needs to be taken into account. PT, either as monotherapy or in addition to surgery, theoretically has shown to improve treatment results dramatically in POSA patients. Prospective, controlled trials focusing on the effects of this combination of treatments should further evaluate this hypothetical conclusion.
authors.affiliation: Department of Otolaryngology/Head Neck Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands, p.vanmaanen@slaz.nl.
authors.forename: J P
authors.initials: JP
authors.lastname: van Maanen
authors.forename: B I
authors.initials: BI
authors.lastname: Witte
authors.forename: N
authors.initials: N
authors.lastname: de Vries
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010160:Palate, Soft / Q000601:surgery*; D056888:Patient Positioning; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014059:Tongue / Q000601:surgery*; D014609:Uvula / Q000601:surgery*