Majority of OSA Patients Are Satisfied 24 Months After Uvulopalatopharyngoplasty

by Literature Review •

What are the satisfaction rates, recommendations, regrets, subjective taste disturbances, and individually reported side effects following a modified uvulopalatopharyngoplasty (UPPP) technique to treat obstructive sleep apnea (OSA)?

BOTTOM LINE: The majority of OSA patients were satisfied 24 months after surgery, even though a third of them were experiencing side effects. Younger patients had fewer side effects than did older patients, and patients with better OSA outcomes were more satisfied.

BACKGROUND: A high side effect rate and a lack of randomized controlled trials (RCTs) showing the effect of UPPP on OSA have led to a decrease in UPPP procedures over the last 10 years. As demonstrated in two RCTs, however, UPPP has a significant effect on OSA. The study authors’ research group performs a conservative UPPP technique, slightly modified to better preserve the soft palate and uvula.

STUDY DESIGN: Prospective intervention study of 65 patients who underwent modified UPPP after failing nonsurgical treatment; patient questionnaires were given at six (52 patients) and 24 (48 patients) months after surgery, while patients reporting side effects or regretting the surgery after 24 months were selected for phone interviews nine years after surgery (16 patients).

SETTING: Department of Surgical Sciences, Otorhinolaryngology–Head and Neck Surgery, Uppsala University, Uppsala, Sweden.

SYNOPSIS: Two of 52 patients regretted the surgery at six months; only one was still dissatisfied after 24 months. Three patients of 48 regretted it at 24 months; two of these three were dissatisfied, did not recommend the surgery, and had moderate side effects. At the six-month follow-up, 20 of 48 patients reported that they had side effects (nine mild, five moderate, four severe, two not evaluated). At the 24-month follow-up, 15 of 48 patients reported side effects (five mild, seven moderate, three severe). There were significant correlations among several parameters, including among age and surgery recommendation, side effects, and degree of side effects, and among surgery satisfaction and changes in AHI and ESS scores and degree of side effects. Four of 16 patients were discontented with the surgery after nine years, mainly because they experienced an insufficient effect on their OSA. Nine of 13 patients with side effects still had them, but only to a minor degree. Limitations included the small cohort size, risk of recall bias, and lack of objective voice/swallowing disorder data.

CITATION: Friberg D, Sundman J, Browaldh N. Long-term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty. Laryngoscope. 2020;130:263-268. doi: 10.1002/lary.27917.