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.



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