Author(s): Powell N, Riley R, Guilleminault C, Troell R
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Abstract Velopharyngeal incompetence (VPI) is a recognized complication of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea. A new uvulopalatal flap (UPF) technique that modifies the UPPP and reduces this risk is presented. The technique achieves the same anatomic results as the UPPP but is reversible. To evaluate clinical outcomes of this new procedure, selected variables were compared in patients who underwent UPPP and UPF procedures. Eighty patients were examined (59/80 UPF, 21/80 UPPP) in a prospective and consecutive manner. Subjects underwent polysomnography and extensive airway evaluations. The characteristics of all patients, at baseline, were evaluated. The study variables included age, sex, body mass index (BMI), palatal length (PNS P) in millimeters, respiratory disturbance index (RDI), lowest oxygen saturation during sleep and a subjective snoring scale. Sixty-seven of the 80 patients underwent simultaneous hypopharyngeal surgery. Data were analyzed with a SAS program. No statistical difference existed between groups. The postoperative character of the palate and the change in snoring scores were the same in all patients (p = 0.584). A positive correlation existed between improvement in the snoring score and the amount of tissue removed or repositioned in the patients treated with UPF (correlation coefficient = 0.370, p = 0.004). In contrast, there was a negative correlation in the UPPP group for the same parameters (correlation coefficient = -0.195, P = 0.409). This suggests there was a difference between these two groups despite the fact that the baseline and postoperative lengths, as well as tissue removed or repositioned, were equivalent. This further suggests that the UPF may reduce snoring to a greater extent than the UPPP. No significant complications were seen in either group. There was no evidence of VPI, even in the early postoperative period. The new reported procedure is reversible and conservative and reduces the risk of VPI. Snoring is improved, which is consistent with a decrease in airway resistance or obstruction.
This article was published in Sleep
and referenced in Journal of Sleep Disorders & Therapy