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Positive airway pressure is recognised as the first-line treatment for moderate to severe obstructive sleep apnoea (OSA) in many countries because of its low risks and high efficacy. Unfortunately, between 30% and 40% of OSA patients cannot tolerate positive airway pressure1 ,2 and may consider other options, including surgery. The most common surgical treatment is isolated palate surgery (often one of the available uvulopalatopharyngoplasty techniques, with tonsillectomy for patients with palatine tonsils). Palate surgery has demonstrated improvements in measures of sleep-disordered breathing severity, such as the apnoea-hypopnea index (AHI),3 and has been associated with clinical benefits, such as improved quality of life,4 reduction in cardiovascular events5 and decreased mortality6 in cohort studies. However, the role of palate surgery (really, all surgery) remains controversial, because surgical outcomes can vary widely.
Browaldh and colleagues present the largest randomised trial comparing uvulopalatopharyngoplasty and tonsillectomy to observation alone for the treatment of moderate to severe OSA. With subjects who were primarily men, and had failed positive airway pressure and mandibular repositioning devices, …
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