Uvulopalatal flap for obstructive sleep apnea on an outpatient basis

Abstract

Objective: Obstructive sleep apnea (OSA) is now seen as one end of a spectrum of sleep-related breathing disorders. It is associated with hypertension, cardiovascular diseases, daytime sleepiness and risk for general anesthesia. Since the introduction of uvulopalatopharyngoplasty (UPPP), many other procedures have been introduced to alleviate palatal abnormalities seen in patients with OSA. A reversible uvulopalatal flap (UPF) performed under general anesthesia also achieves the same results as UPPP, but with less postoperative discomfort. The purpose of this study was to assess the safety and efficacy of UPF for the treatment of OSA on an outpatient basis. Methods: UPF was performed in 36 OSA patients on an outpatient basis under local anesthesia. The mucosa on the lingual surface of the uvula and soft palate was removed with cold-knife dissection. The uvular tip was amputated. The uvula was reflected back toward the soft palate and sutured. Data on patients were compared from preoperative to postoperative assessment points. Statistical analysis was performed using Student t test. Results: Patients had a mean age of 30.2 years and a mean body mass index of 28.5 kg/m2. Most of the patients were male. All patients tolerated the procedure well and it was performed in an average of 20 minutes. The mean follow-up was 6 months (range 4-8 months). Responders were defined as OSA patients who had a reduction in RDI of 50% or more and RDI of 10 or less after surgery. By these criteria, 52% of patients were considered to have responded to UPF. Mean RDI improved from 45.2±10.2 to 10.1±4.2 (p<0.001). The Epworth sleepiness scale improved from 12.5 ± 5.4 to 8.2 ± 4.8 (p<0.001). Postoperative complications included transient nasal regurgitation in 11.1% and foreign body sensation in 8.3%. Bleeding, dysphasia, infection, and nasopharyngeal stenosis were not observed. Most patients had mild-to-moderate pain (visual analog scale ≤ 7) for 5 to 7 days after procedure. Conclusion: UPF results in both significant reductions in respiratory disturbance index and clinical improvements in snoring and sleepiness. It appears to be a well-tolerated outpatient surgical procedure for the treatment of OSA.