Long-term outcomes of cases after uvulopalatopharyngoplasty surgery: a retrospective study

Abstract

Aims: This study aims to evaluate late-term postoperative anatomical, radiological, and polysomnographic study findings after uvulopalatopharyngoplasty surgery and describe the relationships between these findings. Methods: This cross-sectional, retrospective study had a population of all cases undergone mentioned surgery in the department of otolaryngology at a university hospital between January 2005 and December 2008. Demographic variables (age, gender, time after the surgery), body mass indexes, Epworth Sleepiness Scale scores, anatomic variables (routine and non-routine examination findings and measurements), radiographic variables (computed tomography scans data), polysomnographic variables (Apnea-hypopnea indexes, mean and minimum oxygen saturations) were assessed. The results were reported as odds ratio (95% CI) and p<0.05 was considered to indicate statistical significance. Results: The study sample was composed of 21 cases with available data. There were no statistically significant differences in the distribution of any of the study variables between subjects in different Obstructive Sleep Apnea Syndrome severity groups other than the higher age of the mild group. Severity categories were merged and compared, such as having the syndrome or having a moderate/severe syndrome. A resected uvula was more common in the moderate plus severe Obstructive Sleep Apnea Syndrome (apnea-hypopnea index>15) group (8 vs 2, p=.009). The mean upper alveolar arcus width differed among apnea-hypopnea index<15 and apnea-hypopnea index>15 groups, 4.15±0.21 and 3.93± 0.26, respectively (p=0.04). There was no significant correlation between the Apnea-hypopnea index and the other variables but there were moderate to strong significant correlations between other variables. Conclusion: Uvular length, uvular width and the measurement of the upper alveolar arcus (indicating the maxillary transverse width) differ in cases who have undergone uvulopalatopharyngoplasty surgery and fell into different Obstructive Sleep Apnea Syndrome severity groups determined by a polysomnographic study.

Keywords

• Maxillary transverse width
• Obstructive Sleep Apnea Syndrome (OSAS)
• Polysomnography
• Uvula
• Uvulopalatopharyngoplasty (UPPP)

Ethical Statement

This study is conducted as a medical expertise thesis in the Department of Otolaryngology and Head-Neck Surgery, the Faculty of Medicine of the Manisa Celal Bayar University. Permission was obtained from the relevant institution, and the thesis was presented successfully in 2010. This is specified in the text. The institution where the study was carried out is blinded to the reviewers in the submission text. It is planned to be added to the text after acceptance. Retrospective ethics committee approval is not required for articles that were produced from postgraduate/doctoral studies using research data before 2020.

References

1. Karna B, Sankari A, Tatikonda G. Sleep Disorder. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 11, 2023.
2. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387-1394. doi: 10.1378/chest.14-0970
3. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-747. doi: 10.1016/S0140-6736(13)60734-5
4. Martinovic D, Tokic D, Puizina-Mladinic E, et al. Oromaxillofacial surgery: both a treatment and a possible cause of obstructive sleep apnea-a narrative review. Life. 2023;13(1):142. doi: 10.3390/life13010142
5. Khan A, Ramar K, Maddirala S, Friedman O, Pallanch JF, Olson EJ. Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience. Mayo Clin Proc. 2009;84(9):795-800. doi: 10.4065/84.9.795
6. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 13(3):479-504. doi: 10.5664/jcsm.6506
7. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188(8):996-1004. doi: 10.1164/rccm.201303-0448OC
8. Owens RL, Edwards BA, Eckert DJ, et al. An integrative model of physiological traits can be used to predict obstructive sleep apnea and response to non positive airway pressure therapy. Sleep. 2015;38(6):961-970. doi: 10.5665/sleep.4750

9. Chang JL, Goldberg AN, Alt JA, et al. International consensus statement on obstructive sleep apnea. Int Forum Allergy Rhinol. 2023;13(7):1061-1482. doi: 10.1002/alr.23079
10. Olszewska E, De Vito A, Baptista P, et al. Consensus statements among European Sleep Surgery Experts on snoring and obstructive sleep apnea: part 1 definitions and diagnosis. J Clin Med. 2024;13(2):502. doi: 10.3390/jcm13020502
11. Neelapu BC, Kharbanda OP, Sardana HK, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of cephalometric studies. Sleep Med Rev. 2017;31:79-90. doi: 10.1016/j.smrv.2016.01.007
12. Thuler E, Rabelo FAW, Yui M, Tominaga Q, dos Santos V, Arap SS. Correlation between the transverse dimension of the maxilla, upper airway obstructive site, and OSA severity. J Clin Sleep Med. 2021;17(7):1465-1473. doi: 10.5664/jcsm.9226