Palatal suspension and uvulopalatopharyngoplasty for obstructive sleep apnea

Abstract

Objective: Uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea (OSA) is to enlarge the retropalatal airway by excision of the uvula and posterior portion of the palate. Successful subjective and objective results have been reported, however postoperative pain is severe. Palatal suspension (PS) was developed to open the retropalatal airway without removal of palatal tissue. It anchored the soft palate to the anterior hard palate and enlarged the airway space. The purpose of this study was to compare the efficacy of PS and UPPP in the treatment of OSA patients with palatal obstruction. Materials and Methods: Fifty one patients with OSA and palatal airway obstruction were prospectively enrolled into a randomized, surgical protocol. A comparison of the demographic parameters and disease severity showed that the PS group and the UPPP group were similar. The mean follow-up time was about 3 months. Data on the patients were compared from the preoperative to postoperative assessments and between the groups. Results: In PS group, the AHI decreased from a mean of 39.8 ± 4.9 to 19.4 ± 5.9 (p < 0.01), ESS decreased from a mean of 12.8 ± 3.8 to 6.6 ± 2.9 (p < 0.001), and VAS for snoring decreased from 8.7 ± 1.2 to 3.5 ± 2.3 (p < 0.01). In UPPP group, the AHI decreased from a mean of 40.2 ± 5.8 to 19.8 ± 6.1 (p < 0.001), ESS decreased from a mean of 13.1 ± 4.3 to 6.8 ± 3.1 (p < 0.001), and VAS for snoring decreased from 8.8 ± 0.8 to 3.2 ± 2.3 (p < 0.01). The change scores in patients who underwent PS and UPPP were not of significant difference. Based on the criteria for success that the AHI decreased more than 50% from the baseline and the final AHI was less than twenty, 64% (15 of 25) of PS patients and 65.4% (17 of 26) of UPPP patients achieved a surgical success (p = 0.71). There was statistically significant difference in the first week for postoperative pain between PS and UPPP (6.8 ± 2.2 vs 8.8 ± 2.4, p < 0.001). The mean operative time and blood loss for PS and UPPP were of significant difference (20.8 ± 5.2 minutes vs 30.2 ± 6.2 minutes, p < 0.05 and 10.2 ± 10.5 ml vs 30.8 ± 10.7 ml, p < 0.001). Bleeding, airway obstruction, infection, and extrusion of suture material were not encountered. Conclusion: Palatal suspension is a simple and effective procedure. It can be performed in carefully selected OSA patients with low chance of pain and complications when compares with UPPP. © 2010 Japan International Cultural Exchange Foundation.