Surgical Issues: Insights into UPPP, CPAP Use, and CSF Leaks

ORLANDO, FL-Does multilevel upper airway surgery preclude continuous positive airway pressure (CPAP) usage, and is there a best way to repair cerebrospinal fluid (CSF) leaks? These are among the questions into which researchers provided insight at the recent Combined Otolaryngology Spring Meeting here.

UPPP Patients Can Still Use CPAP

In one surgery-related talk, researchers showed that a history of uvulopalatopharyngoplasty (UPPP) does not preclude the use of CPAP in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). In fact, one study now suggests that patients who have had surgery, yet who have persistent symptoms, can still benefit from CPAP, and may even use lower pressures than were used prior to surgery. Compliance can be improved, too.

This was the finding of a study designed to investigate whether multilevel upper airway surgery precludes CPAP usage in patients. Details were presented at a session of the Triological Society section of the conference. The primary author of the study was Michael Friedman, MD, Professor of Otolaryngology-Head and Neck Surgery at Rush University Medical Center in Chicago; presenting was Rohit Soans, MD, a research fellow at Rush University.

There are a few myths about surgery and CPAP that seem to be common in the field of otolaryngology. The first is that surgery does not help in obstructive sleep apnea. The second is that if surgery fails, you cannot use CPAP again. And third, CPAP compliance is drastically altered by surgery, said Dr. Soans.

The study also investigated whether surgery affected CPAP pressure settings needed by patients, as well as CPAP compliance. A retrospective review was done of 300 patients who had undergone multilevel upper airway surgery for moderate to severe OSAHS. Of these patients, a total of 52 had returned with persistent symptoms and were willing to try CPAP therapy again. They all underwent CPAP titration.

Data included preoperative and postoperative BMI, apnea-hypopnea index (AHI), rapid eye movement (REM) sleep measurements, optimal CPAP pressure settings, and details of CPAP compliance.

Preoperatively, patients had a mean BMI of 31.2, which had not changed at a six-month postoperative follow-up. AHI was a mean of 63.2 prior to surgery, and dropped to 50.1 postoperatively; the change was statistically significant. Minimum oxygen saturation increased from a mean of 71.9% preoperatively to 80.4% six months postsurgery.

These improvements are important because they represent the group that failed surgery, Dr. Friedman told ENT Today in an interview. In the medical literature, the success rate for surgical treatment of OSAHS is reported as being about 40%, he said. This number represents old studies on the efficacy of UPPP as an isolated procedure. Most patients have multilevel surgery, and the success rate is 66%.