Role of UPPP

Given the currently available technology for OSA and considering the significant health implications of this disorder, I tend to use the algorithm shown in Figure 12-1 to provide a basis for managing these patients. In general, after a thorough discussion of OSA and its clinical implications, the success rate and nonsurgical nature of nasal CPAP is emphasized to the patient.

I encourage all patients to seriously consider this alternative. However, many patients cannot or will not use the nasal CPAP alternative, citing that they are frequent business travelers or are claustrophobic or that they simply do not want to be bothered with a mechanical device every night. The importance of altering lifestyle factors such as alcohol or sedative drug intake and body mass index (obesity) should be reemphasized at every opportunity. Dental orthodontic appliances and UPPP should be discussed. Most patients favor the surgical approach because, if it is successful, it has the potential of a one-time treatment. The poor success of this procedure must be honestly discussed with the patient before the patient makes the decision to

OSA Dx on Polysomnography

OSA Dx on Polysomnography

Figure 12-1 Patient diagnosed with obstructive sleep apnea (OSA).

proceed. Although patients often report dramatic symptomatic improvement after undergoing UPPP, a postoperative poly-somnographic study is essential for clear documentation of its success or failure. If the procedure has failed to deliver the patient within a normal AHI range, the need for further treatment (preferably nasal CPAP) must be strongly recommended.

Once considered the panacea for managing OSA, UPPP

has clear and distinct limitations. Although it continues to have a therapeutic role in the surgical management of OSA, its effectiveness is often overestimated both by patients and by physicians. Otolaryngologists must constantly be reminded of the limitations of UPPP and of the significant health implications of inadequately managed OSA when discussing treatment options and making recommendations to patients with this condition.

REFERENCES

Tami—CHAPTER 12

1. Fujita S, Conway W, Zorick F. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvu-lopalatopharyngoplasty. Otolaryngol Head Neck Surg 1981; 89:923-934

2. Schechtman KB, Sher AE, Piccirillo JF. Methodological and statistical problems in sleep apnea research: the literature on uvulopalatopharyngoplasty. Sleep 1995;18:659-666

3. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156-177

4. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 1993;108:117-125

5. Findley LJ, Unverzagt ME, Suratt PM. Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis 1988;138:337-340

6. Findley L, Unverzagt M, Guchu R, et al. Vigilance and automobile accidents in patients with sleep apnea or narcolepsy. Chest 1995;108:619-624

7. Mitler MM. Daytime sleepiness and cognitive functioning in sleep apnea. Sleep 1993;16(8 suppl):S68-70

8. Pack AI. The prevalence of work-related sleep problems [editorial]. J Gen Intern Med 1995;10:57

9. Pakola SJ, Dinges DF, Pack AI. Review of regulations and guidelines for commercial and noncommercial drivers with sleep apnea and narcolepsy. Sleep 1995;18:787-796

10. Shepard JWJ. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med 1992;13:437-458

11. Millman RP, Redline S, Carlisle CC, et al. Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. Chest 1991;99:861-866

12. He J, Kryger MH, Zorick FJ, et al. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988;94:9-14

13. Riley RW, Powell NB, Guilleminault C, et al. Obstructive sleep apnea. Trends in therapy [see comments]. West J Med 1995;162:143-148

14. Smith PL, Gold AR, Meyers DA, et al. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 1985;103(pt 1):850-855

15. Schmidt-Nowara W, Lowe A, Wiegand L, et al. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995;18:501-510

16. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862-865

17. Kribbs NB, Pack AI, Kline LR, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea [see comments]. Am Rev Respir Dis 1993; 147:887-895

18. Reeves-Hoche MK, Meck R, Zwillich CW. Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med 1994;149:149-154

19. Rauscher H, Formanek D, Popp W, Zwick H. Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea. Chest 1993;103:1675-1680

20. Series F, St. Pierre S, Carrier G. Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea. Am Rev Respir Dis 1992;146(pt 1):1261-1265

21. Kamami YV. Outpatient treatment of snoring with CO2 laser: laser-assisted UPPP. J Otolaryngol 1994;23:391-394

22. Macdougald I. Sleep apnoea. Laser therapy for OSAS. Nurs Times 1994;90:32-34

23. Mickelson SA. Laser-assisted uvulopalatoplasty for obstructive sleep apnea. Laryngoscope 1996;106:10-13

24. Walker RP, Grigg-Damberger MM, Gopalsami C, Totten MC. Laser-assisted uvulopalatoplasty for snoring and obstructive sleep apnea: results in 170 patients. Laryngoscope 1995; 105(pt 1):938-943

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

Get My Free Ebook


Post a comment