Polysomnographic Outcomes Before and After Modified Uvulopalatopharyngoplasty Alone or With Minimally Invasive Surgery for Patients with Obstructive Sleep Apnea
Noppadon Triprateepsilp¹, Wish Banhiran², Wattanachai Chotinaiwattarakul³, Phawin Keskool², Sarin Rungmanee⁴, Surintorn Wongvilairat⁵, Kanyarat Khamproh⁶
Affiliation : ¹ Department of Otorhinolaryngology, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, ² Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, ³ Division of Neurology, Department of Neurology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, ⁴ Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, ⁵ Somdej Phrachao Taksin Maharat Hospital, Tak, Thailand, ⁶ Fort Suranari Hospital, Nakhon Ratchasima, Thailand
Objective: To evaluate the polysomnographic (PSG) outcomes before and after modified uvulopalatopharyngoplasty (Mod UPPP) alone or with minimally invasive surgery (MIS) for patients with obstructive sleep apnea (OSA).
Materials and Methods: The present study was a retrospective study included OSA patients aged 18 years or older who underwent Mod UPPP alone or with MIS as radiofrequency (RF) ablation of the nose and tongue base, at Siriraj Hospital between January 2014 and October 2019. Those with incomplete PSG data or sleep efficiency of less than 50% were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were the sleep stages’ proportions, lowest oxygen saturation (LSAT), oxygen desaturation index (ODI), time with oxygen saturation of less than 90% (T90), surgical success and response rates, and postoperative complications.
Results: Seventy-five 75 patients including 59 males and 16 females, with a mean age of 41.6±10.8 years old and body mass index (BMI) of 30±6 kg/m² were included in the study. The mean follow-up time of PSG was 11.5±10.2 months. The postoperative results showed mean reductions of AHI from 42.3 to 19.2 events/hour (p<0.001), ODI of 4% or less from 39 to 17.4 events/hour (p<0.001), T90 from 16% to 6.1% (p<0.001), and an increase in LSAT from 74.1% to 81.9% (p<0.001). Overall, the surgical success and response rates for Mod UPPP alone and with MIS were 33.3% and 49.3%, respectively. However, no statistical reduction of AHI was found between these groups. Secondary bleeding was found postoperatively in three patients or 4%, in which two of them required intervention for hemostasis. No serious complications, such as respiratory distress or death, were found.
Conclusion: Mod UPPP alone or with MIS significantly improved the PSG outcomes with a low complication rate, suggesting it may be considered an alternative treatment for Thai patients with OSA.
Received 18 October 2021 | Revised 25 August 2022 | Accepted 5 September 2022
DOI: 10.35755/jmedassocthai.2022.10.13678
Keywords : Obstructive sleep apnea; Palatal surgery; Minimally invasive surgery; Modified UPPP; Anterior palatoplasty; Thai
