Unpredictable results of laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnoea
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Dr C F Ryan, Division of Respiratory Medicine, Vancouver General Hospital, 2775 Heather Street, Vancouver, British Columbia, V5Z 3J5 Canada email: fryan{at}interchange.ubc.ca
- Received 22 November 1999
- Revision requested 12 January 2000
- Revised 8 February 2000
- Accepted 8 February 2000
Abstract
BACKGROUND Laser assisted uvulopalatoplasty (LAUP) is increasingly offered for the treatment of obstructive sleep apnoea (OSA), although there is a lack of objective data to support its indications and efficacy. A study was undertaken to determine the treatment response to LAUP.
METHODS Overnight polysomnography was performed before and at least three months after surgery in 44 consecutive patients with symptomatic mild to moderate OSA (apnoea + hypopnoea index (AHI) >10/h). Pharyngeal dimensions were measured by videoendoscopy (n = 11) and disease-specific quality of life, sleepiness and snoring frequency (n = 16) before and after surgery were determined in subgroups of patients. LAUP was performed under local anaesthesia as a one stage resection of the uvula and soft palate by one of two experienced otolaryngologists.
RESULTS Twelve patients (27%) had a good response (AHI ≤10/h after LAUP); four (9%) had a partial response (AHI ≤50% of pre-LAUP value); 15 (34%) had a poor response (AHI >50% of pre-LAUP value); and 13 (30%) patients were worse (AHI >100% of pre-LAUP value). The velopharyngeal cross sectional area and anteroposterior diameter increased following LAUP (p<0.05). Quality of life indices improved significantly in all domains and sleepiness decreased. The snoring index did not decrease significantly. No preoperative anthropometric or videoendoscopic measures were predictive of a good response to LAUP. Patients who were worse after LAUP had milder baseline apnoea severity than those in the other response groups.
CONCLUSIONS The treatment response to LAUP is variable and unpredictable, and only a few patients achieve a satisfactory response. There appears to be no relationship between subjective and objective measures of treatment efficacy.
Footnotes
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Funding: This study was supported by the British Columbia Lung Association. Dr Ryan is supported by a Scientist Award from the British Columbia Lung Association and Vancouver General Hospital.
