title: Beyond uvulopalatopharyngoplasty for obstructive sleep apnoea: single surgeon case series of contemporary airway reconstruction.
abstract: OBJECTIVE
  Adult patients with obstructive sleep apnoea can be a therapeutic surgical challenge if other treatments fail or are rejected. We report the outcomes of a series of 17 patients for whom standard device-based treatments failed or could not be used. These patients were considered unsuitable for a lesser operation and therefore underwent multilevel upper airway reconstruction.
  
  
  METHODS
  Data from 17 consecutive patients were collected prospectively. This included pre- and post-surgery findings for clinical assessments, body mass index, sleep questionnaires, and laboratory polysomnograms. Patients underwent a combination of modified uvulopalatopharyngoplasty, transpalatal advancement and various tongue reduction procedures.
  
  
  RESULTS
  Analyses revealed statistically and clinically significant reductions in: mean apnoea-hypopnoea index scores (from 36.3 pre-operatively to 14.5 post-operatively, p < 0.001), mean Epworth sleepiness scale scores (from 11.3 to 5.3, p < 0.001) and mean snoring severity scores (from 6.9 to 1.3, p < 0.001). Body mass index remained unchanged.
  
  
  CONCLUSIONS
  Multilevel upper airway reconstructive surgery was associated with large reductions in both objective and patient-centred subjective measures of obstructive sleep apnoea severity.
authors: Department of Otolaryngology Head Neck Surgery, The Wollongong Hospital, Australia.
authors: S G
authors: SG
authors: Mackay
authors: Department of Otolaryngology Head Neck Surgery, The Wollongong Hospital, Australia.
authors: N
authors: N
authors: Jefferson
authors: Sydney Nursing School, and the National Health and Medical Research Council Centre for Integrated Research and Understanding of Sleep, The University of Sydney, Australia.
authors: N S
authors: NS
authors: Marshall
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery*; D011795:Surveys and Questionnaires; D014059:Tongue / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery*