Can an anatomy-based staging system effectively predict the efficacy of uvulopalatopharyngoplasty (UPPP) performed along with nasal surgery?
Background: While the overall efficacy of UPPP is estimated at 40 percent, Friedman and colleagues published a series of 134 patients who were staged based upon oral cavity exam and body mass index (BMI) (Otolaryngol Head Neck Surg. 2002;127:13-21). The success of UPPP correlated closely with this anatomy-based staging system.
Explore this issue:August 2011
Study design: Pre-post comparison study.
Setting: A university hospital in Korea.
Synopsis: Forty-one consecutive male patients with obstructive sleep apnea syndrome (OSAS) underwent UPPP and concomitant nasal surgery with polysomnography performed before and after surgery. The overall apnea hypopnea index (AHI) decreased from 45.9 +/- 23.4 to 20.9 +/- 22.1 events/hour with a 56 percent success rate. Patients with grade 1 or 2 tonsils with modified Mallampati score (MMS) of 1 or 2 (stage 1) had a success rate of 71 percent. Sixty percent of stage 2 patients (grade 1/2 tonsils with MMS 1/2 or grade 3/4 tonsils with MMS 3/4) were successfully treated, as were 22 percent of stage 3 patients (grade 1/2 tonsils with MMS 3/4). The overall success rate is higher than expected, likely because most of the patients (32 out of 41) were stage 1 or 2. In addition, there were no women included in this study, and the sample size, once stratified, is relatively small.
While success rates are slightly higher than those published by Friedman and colleagues, the dose response curve seen with this anatomic staging system suggests that this is an effective method for stratifying surgical OSA patients for possible UPPP with nasal surgery.
Bottom line: Male OSA patients with large tonsils and a low MMS score have a high likelihood of improvement of OSA to an AHI below 20, while men with small tonsils and a high MMS score are highly likely to have persistent OSA after UPPP with nasal surgery.
Citation: Cho JH, Kim EJ, Cho WS, et al. Efficacy of single-staged modified uvulopalatopharyngoplasty with nasal surgery in adults with obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2011;144(6):994-999.
-Reviewed by Stacey Ishman, MD