LANDMARK: Uvulopalatopharyngoplasty (UPPP) for treatment of obstructive sleep apnea

Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty

Shiro Fujita, MD, William Conway, MD, Frank Zorick, MD and Thomas Roth, PhD

Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981;89(6):923-34.

Take Home Points:

    • Major finding: when the redundant tissue in the oropharynx is surgically removed as in the UPPP, the upper airway causes of sleep apnea are dramatically improved but not eliminated entirely
    • Factors contributing to pharyngeal collapse:
        • Failure of involuntary control of the pharyngeal muscle by CNS,
        • Surrounding atmospheric pressure
        • Weight of neck tissue
        • Local resistance
      • Degree of negative intrathoracic pressure
  • UPPP is effective by decreasing airflow resistance and inspiratory intrathoracic negative pressure by enlarging oropharynx.

The Details:

    • 12 patients with OSA were selected; 11 male and 1 female
    • All patients underwent complete history, physical exam including otolaryngologic exam, and polysomnography
    • Clinical polysomnography was performed both pre-operatively and post-operatively
    • Patients mostly had shallow oropharyngeal space, with relatively large uvula and redundant tissue surrounding tissue including posterior pillar and posterior pharyngeal wall. The purpose of the UPPP procedure was to remove redundant tissue while maintaining muscular layer
    • To perform the procedure, the surgeon first performed a tonsillectomy if not already done previously. The remaining steps can be seen in Fig 2, 3, 4 within the paper.
    • Evaluated by using the following variables: changes of sleep pattern, nocturnal respiration, subjective estimate of daytime sleepiness, and level of snoring. The study also evaluated the following apnea parameters: apneas per hour, duration of apnea, minutes SaO2 <85%/hr, and AAR per hr.
    • There were no complications
    • All patient improved in daytime sleepiness and snoring
    • Apnea parameters: apneas per hour, duration of apnea, minutes SaO2 <85%/hr, AAR per hour were all statistically significantly decreased EXCEPT duration of apnea between pre surgical and post surgical recordings.
  • Sleep stages: Stage 1 decreased and Stage 2 increased post surgery. However, neither stage 3, 4 nor REM sleep were significantly changed.

Summary contributed by Sahil Patel