Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Tuesday, May 11, 2010

UPPP Failure and limited success at Cleveland Clinic. Is it time to Abandon UP3 surgery as pPrimary Apnea Treatment

An article "UTILITY OF UPPP IN OSA: THE CLEVELAND CLINIC EXPERIENCE by Lee-Iannotti JK, Bae CJ, Kominsky A, Alsheikhtaha Z reviews the results of UPPP (UP3) surgery on 28 patients who met study criteria from 250 charts reviewed.

These 28 patients unerwent Uvulopalatopharyngealplasty, with or without tonsilectomy and/or septoplasty. ONLY 2 PATIENTS (6.6%) WERE "CURED" HAVING AN AHI OF LESS THAN "5". THE STUDY STATES THAT THERE WAS A 43 % SUCCESS RATE. HOWEVER SUCCESS WAS DEFINED AS 50% REDUCTION AND AHI OF LESS THATN 20. THESE PATIENTS STILL HAD MILD TO MODERATE SLEEP APNEA!

THE STUDY REPORTED " Overall, there was a decrease in the overall AHI in all the patients undergoing surgery (mean AHI ± SD, 45.6 ± 29.2 pre-UPPP vs. 30.4 ± 26.1 post-UPPP, P = 0.019*.) Thirteen patients (43%) achieved a 50% or greater reduction
in the AHI and/or an AHI of 20 or less.

The study showed no reduction in CPAP pressures: " Of the patients requiring CPAP therapy post-UPPP, there was
no significant decrease in pressure requirements (mean CPAP pressure
± SD, 9.4 ± 0.5 pre-operatively vs. 9.1 ± 0.7 post-operatively, P = 0.35.)"

The authors concluded that: "UPPP achieved surgical success in 43% of our patients. Younger patients (< 40 years) with lower Friedman scores (≤ 2) seemed to have greater surgical success rates. BMI, neck circumference, tonsil-
lar size, severity of OSA and presence of retrognathia did not seem to be predictors of outcome.

EXCEPT FOR YOUNGER AGES AND LOWER TONGUE POSITION THERE WERE NO PREDICTORS OF POSITIVE SUCCESS. BASED ON THIS STUDY THE USE OF UPPP SURGERY IN ADULTS OVER 18 IS QUESTIONABLE AT BEST.

BOTH CPAP AND ORAL APPLIANCES ARE MUCH MORE SUCCESSFUL EVEN WHEN POOR CPAP COMPLIANCE IS CONSIDERED.

COMPARED TO SURGERY ORAL APPLIANCES ARE DEFINITIVELY A BETTER TREATMENT CHOICE. CPAP IS A SUPERIOR CHOICE IF IT IS USED ALL NIGHT ON A REGULAR BASIS.

ONE ADVANTAGE TO SURGERY IS THAT PATIENT COMPLIANCE IS A NON-ISSUE.

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posted by Dr Shapira at 12:23 PM