Modified UPPP Improves Daytime Sleepiness, QOL in OSA

What role does modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, play in the daytime sleepiness and quality of life (QOL) in patients with obstructive sleep apnea syndrome (OSAS)?

Background: OSAS is associated with increased morbidity and mortality, as well as increased risk of poor sleep and low QOL, excessive daytime sleepiness, and traffic accidents. UPPP was the predominant OSAS treatment before continuous positive airway pressure (CPAP) devices became widely available; however, the role of UPPP has been questioned because of side effects, complications, and a lack of OSAS treatment efficacy.

Study design: Prospective randomized controlled trial of 65 patients, with two parallel arms; the intervention group (32 patients) underwent surgery between June 2007 and May 2011, while the controls (33 patients) had no treatment.

Setting: Otorhinolaryngology Department of the Karolinska University Hospital in Huddinge, Stockholm, Sweden.

Synopsis: The median Epworth Sleepiness Scale (ESS) score significantly decreased, from 12 to six. In the intervention group, all Health Survey SF-36 domains showed improvements, which were statistically significant for role physical (RP), general health (GH), vitality (VT), social functioning (SF), mental health (MH), mental component summary (MCS), and physical component summary (PCS). In the available data analysis for vigilance testing, the intervention group’s median sleep latency was significantly changed, from 38.4 to 40 minutes. Before intervention, nine out of 22 patients passed the vigilance test; at follow-up, 20 of 22 patients passed. There were significant weak to moderate correlations between changes in ESS and apnea-hypopnea index (AHI); SF-36 domains SF, VT, and MCS; and sleep latency. Limitations included a power analysis based on calculations from the authors’ original study rather than secondary outcomes in this study, missing data and dropouts for the vigilance test in both groups, and use of the modified Oxford Sleep Resistance test rather than the gold standard maintenance of wakefulness test.

Bottom line: Modified UPPP was effective in improving daytime sleepiness and QOL in OSAS patients.

Citation: Browaldh N, Bring J, Friberg D. SKUP3 RCT; continuous study: changes in sleepiness and quality of life after modified UPPP. Laryngoscope. 2016;126:1481-1483.