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An Effective and Safe Technique for Selected Patients With Obstructive Sleep Apnea Syndrome

Tsung-Wei Huang, MD; Po-Wen Cheng, MD, PhD

Arch Otolaryngol Head Neck Surg. 2008;134(2):141-145.

Objective  To assess subjective and objective outcomes in selected patients with obstructive sleep apnea syndrome who underwent microdebrider-assisted extended uvulopalatoplasty (MEUP).

Design  Prospective study.

Setting  Tertiary referral center.

Patients  Fifty patients with obstructive sleep apnea syndrome who had substantial retropalatal obstruction and more than 10 events per hour on the respiratory disturbance index (RDI) and who underwent MEUP with 6 months of follow-up. Patients with a Friedman palate position of grade 4 and a tonsil size of grade 3 or 4 were excluded.

Intervention  MEUP was performed in each patient under general anesthesia. The procedure consisted of removal of the redundant mucosa, tissue above the muscular layer of the soft palate, and upper poles of the tonsils using a powered microdebrider.

Main Outcome Measures  Postoperative pain was evaluated using a visual analog scale. Before surgery and at 6 months after surgery, subjective outcomes were assessed using the Epworth Sleepiness Scale and the snoring scale, and objective outcomes were assessed using overnight polysomnography variables (RDI, snoring index, and minimal oxygen saturation). Surgical success was defined as achieving a postoperative RDI score of fewer than 20 events per hour and a greater than 50% reduction in the preoperative RDI score.

Results  The mean (SD) visual analog scale scores were 3.9 (1.8) on the first postoperative day and 1.3 (0.9) on the seventh postoperative day. Compared with preoperative scores, postoperative scores statistically significantly improved on the Epworth Sleepiness Scale and on the snoring scale (P < .01 for both). The median RDI score decreased from 37.9 events per hour before surgery to 6.1 events per hour at 6 months after surgery, a statistically significant difference (P < .001). The median minimal oxygen saturation and snoring index scores also improved statistically significantly (P < .001 for both). The surgical success rate was 80% (40 of 50 patients). No postoperative bleeding or long-term velopharyngeal insufficiency was observed in any patient.

Conclusions  MEUP is an effective and safe surgical procedure to improve sleep apnea and snoring in selected patients with obstructive sleep apnea syndrome. The use of the microdebrider in extended uvulopalatoplasty is addressed herein for the first time (to our knowledge).

Author Affiliations: Department of Otolaryngology, Far Eastern Memorial Hospital (Drs Huang and Cheng), Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University (Dr Huang), and Department of Nursing, Oriental Institute of Technology (Dr Cheng), Taipei, Taiwan.