A surgical procedure to treat obstructive sleep apnea syndrome by uvulopalatopharyngoplasty (UPPP) was first described by Fujita et al. Eight of 12 patients experienced objective improvement in nocturnal respiration and sleep as demonstrated by polysomnography six weeks after surgery. A second series of ten patients undergoing palatopharyngoplasty (a procedure similar to UPPP) all had complete symptomatic relief and polysomnography confirmed the result in one patient. Since these early reports, patients at a number of different centers have undergone UPPP, or procedures closely related technically, but there are only two published reports of the effectiveness of surgery in large groups of patients.
Three month postsurgery polysomnographic evaluation in 35 of 69 patients who had palatopharyngoplasty was reported recently. Of those not evaluated, 30 had significant subjective improvement but refused polysomnography, and four had returned to their homes outside the USA and were not contacted. In the group evaluated, measures of respiration during sleep improved significantly, but individually some patients did not improve and some worsened. The second report is a consecutive series of 66 patients before and six weeks after UPPP. While UPPP significantly improved excessive daytime sleepiness, reduced by half the frequency of apneas and hypoxemia during sleep and improved sleep quality, all patients did not benefit to the same degree. In 33 patients, classified as responders, the signs and symptoms of obstructive sleep apnea were almost completely reversed. In the remaining 33, only hypoxemia during sleep was improved, although none got worse. It is clear from these two studies that UPPP benefits some patients and the critical question is how can those who will respond be identified. Studies to address this issue are being conducted presently at several centers.
A second and equally important question is the duration of the beneficial effect achieved with UPPP or related techniques. Presently there are no long-term followup data. The surgical procedure is designed to lessen obstruction of the airway by removing redundant tissue in the oropharynx. However, redundant tissue may return over time, possibly with weight gain, since excessive body weight is a contributing etiologic factor. Long-term follow-up data on UPPP are essential.
This article presents an evaluation of the long-term effect (one year) of UPPP on the signs and symptoms of sleep apnea in patients who responded positively to the surgery. It is rather interesting to be in touch with different aspects of medical science. We may make your way easy together with the special website.
Material and Methods
As described previously, 66 consecutive unselected patients with obstructive sleep apnea syndrome underwent UPPP for treatment of their apnea. All had evidence on a presurgery polysomnogram of repeated obstructive respiratory events during sleep. On repeat polysomnographic evaluation six weeks after surgery, 33 of these patients had at least a 50 percent reduction in apnea index and were classified as responders. These 33 patients are the subjects of this report. There were 30 men and three women with a mean age of 47.2 years. All were greater than 125 percent of ideal body weight, weighing a mean of 280.9 pounds.
Nine to 15 months after surgery, each of the 33 patients classified as responders was contacted by telephone to arrange a fbllowup polysomnographic evaluation. The nocturnal polysomnography, as in the pre- and postsurgery evaluation, consisted of a standard electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG), as well as measures of cardiac and respiratory functioning. Airflow was measured by nasal and oral thermistors and respiratory effort by a mercury-filled strain gauge stretched over the abdomen. Oxygenation was monitored with a Hewlett-Packard ear oximeter. A V2 or V5 lead recorded heart rate.
All nocturnal polysomnograms were scored for sleep stages using standard criteria. Respiratory tracings were evaluated for the presence of apnea (a 10-second or greater cessation of breathing). Oximetry tracings were scored for the number of times and total minutes that oxygen saturation dropped below 85 percent during sleep and the lowest level of oxygen saturation. Finally, the number of arousals associated with respiration (AAR) were counted. This measure included both apneas (complete cessation of airflow) and hypopneas in which respiratory effort and airflow are reduced periodically, producing arousals when terminated. An AAR was defined as an increase in leg or chin muscle tonus occurring in association with a change in respiration (ie, termination of an apneic or hypopneic event).