Skip to main content
SpringerLink
Log in

Oropharyngeal surgery for obstructive sleep apnoea in CPAP failures

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Continuous positive airway pressure (CPAP) for moderate and severe obstructive sleep apnoea (OSA), albeit effective management, is poorly tolerated. This study looks at the role of laser assisted uvulopalatoplasty (LAUP) in patients with moderate and severe OSA who would not tolerate CPAP. All subjects underwent dynamic sleep nasendoscopy to determine the anatomical level of obstruction and their suitability for the procedure. Twenty subjects were included. Pre-procedure mean apnoea-hypopnea index (AHI) was 47.9 per hour (21.3–101) and mean Epworth sleepiness score 15.6 (4–23). Post operative polysomnography at ≥4 months showed a 73% reduction in AHI to a mean of 12.9 per hour. Two subjects still required CPAP post procedure but both at reduced pressure. Epworth sleepiness questionnaire scores were reduced by a mean of 7.9 points. There was no confounding weight loss. The finding that LAUP offers an effective instrument to reduce the severity of OSA in patients intolerant of CPAP results disagree with the conclusion of the recent Cochrane Collabration review of surgery for OSA. We believe this is due to the careful selection of patients for LAUP based on the anatomical level of obstruction as opposed to random selection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lugaresi E, CirignottaG, Coccagana G, Piiana C (1980) Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep 3:221–224

    PubMed  CAS  Google Scholar 

  2. Guilleminault C, Connolly S, Winkle R (1983) Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnoea syndrome. Am J Cardiol 52:490–494

    Article  PubMed  CAS  Google Scholar 

  3. Partinen M, Jamieson A, Guilleminault C (1988) Long term outcome for obstructive sleep apnoea syndrome patients: mortality. Chest 94:1200–1204

    Article  PubMed  CAS  Google Scholar 

  4. He J, Kryger MH, Zorick FJ, Conway W, Roth T (1988) Mortality and apnoea index in obstructive sleep apnoea: experience of 385 male patients. Chest 94:9–14

    Article  PubMed  CAS  Google Scholar 

  5. Scher AI, Lipton RB, Stewart WF (2003) Habitual snoring as a risk factor for chronic daily headache. Neurology 60(8):1366–1368

    PubMed  CAS  Google Scholar 

  6. Findley LJ, Barth JT, Powers DC et al (1986) Cognitive impairments in patients with obstructive sleep apnoea and associated hypoxemia. Chest 909:686–689

    Article  Google Scholar 

  7. Findley LJ, Unverzagt ME, Surratt PM (1998) Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis 139:337–340

    Google Scholar 

  8. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep disordered breathing among middle age adults. N Eng J Med 328:1230–1235

    Article  CAS  Google Scholar 

  9. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    PubMed  CAS  Google Scholar 

  10. Giudici S, Farmer W, Dollinger A, Andrada T, Torrington K, Rajagopal K (2000) Lack of predictive value of the Epworth Sleepiness Scale in patients after uvulopalatopharyngoplasty. Ann Otol Rhinol Laryngol 109(7):646–649

    PubMed  CAS  Google Scholar 

  11. Laube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA (1999) Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest 115:863–866

    Article  Google Scholar 

  12. Engelman HM, Martin SE, Douglas NJ (1994) Compliance with CPAP therapy in patients with sleep apnea/hypopnea syndrome. Thorax 49:263–266

    Article  Google Scholar 

  13. Reeves–Hooche MK, Meck R, Zwillich CW (1994) Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med 149:149–154

    Google Scholar 

  14. Larrosa F, Hernandez L, Morello A, Ballester E, Quinto L, Montserrat JM (2004) Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations? Eur Respir J 24(1):66–70

    Article  PubMed  CAS  Google Scholar 

  15. Sundaram S, Bridgman S, Lim J, Lasserson T (2005) Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev (4):CD001004

  16. Croft CB, Pringle MB (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol 16:504–509

    Article  PubMed  CAS  Google Scholar 

  17. Battagel JM, Johal A, Kotecha B (2005) Sleep nasendoscopy as a predictor of treatment success in snorers using mandibular advancement splints. J Laryngol Otol 119(2):106–112

    Article  PubMed  CAS  Google Scholar 

  18. Patel N, Gill J, Kotecha B (2005) How I do it-the Kotecha technique for laser palatoplasty. Eur Arch Otorhinolaryngol

  19. Kamami YV (1990) Laser CO2 for snoring—preliminary results. Acta Otorhinolaryngol Belg 44:451–456

    PubMed  CAS  Google Scholar 

  20. Kamami YV (1994) Outpatient treatment of sleep disordered breathing with CO2 laser assisted UPPP. J Otolaryngol 25:155–161

    Google Scholar 

  21. Dickson RI, Mintz DR (1996) One stage laser assisted uvulopalatoplasty. J Otolaryngol 25:155–161

    PubMed  CAS  Google Scholar 

  22. Terris DJ, Wang MZ (1998) Laser assisted uvulopalatoplasty in mild obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 124:718–722

    PubMed  CAS  Google Scholar 

  23. Lauretano AM, Khosla RK, Richardson CT et al (1997) Efficacy of laser assisted uvulopalatoplasty. Laser Surg Med 21:109–116

    Article  CAS  Google Scholar 

  24. Utley DS, Shin EJ, Clark AA et al (1997) A cost effective and rational surgical approach to patients with snoring, upper airway resistance syndrome, or obstructive sleep apnea syndrome. Laryngoscope 107:76–82

    Article  Google Scholar 

  25. Mickelson SA (1996) Laser assisted uvulopalatoplasty for obstructive sleep apnea. Laryngoscope 106:10–13

    Article  PubMed  CAS  Google Scholar 

  26. Kern RC, Kutler DI, Reid KJ et al (2003) Laser assisted uvulopalatoplasty and tonsillectomy for the management of obstructive sleep apnea syndrome. Laryngoscope 113:1175–1181

    Article  PubMed  Google Scholar 

  27. Walker RP, Grigg-Damberger MM, Gopalsami C (1999) Laser assisted uvulopaltoplasty for the treatment of mild, moderate and severe obstructive sleep apnea. Laryngoscope 109:79–85

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  29. Mickelson SA, Ahuja A (1999) Short term objective and long term subjective results of laser assisted uvulopalatoplasty for obstructive sleep apnea. Laryngoscope 109:362–367

    Article  PubMed  CAS  Google Scholar 

  30. Seemann R, DiToppa JC, Holm MA, Hanson J (2002) Combination surgical and mechanical therapy for refractory cases of obstructive sleep apnea. J Otolaryngol 31(2):85–88

    Article  PubMed  Google Scholar 

  31. Ryan CF, Love LL (2000) Unpredictable results of laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnoea. Thorax 55:399–404

    Article  PubMed  CAS  Google Scholar 

  32. Ferguson KA, Heighway K, Ruby RRF (2003) A randomised trial of laser assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea. Am J Resp Crit Care Med 167:15–19

    Article  PubMed  Google Scholar 

  33. Hoffestein V (1996) Snoring. Chest 109:201–222

    Article  Google Scholar 

  34. Berry S, Roblin G, Williams A, Watkins A, Whittet HB (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115:538–540

    Article  PubMed  CAS  Google Scholar 

  35. Georgalas C, Kotecha B (2004) Predictive value of sleep nasendoscopy in the management of habitual snorers. Ann Otol Rhinol Laryngol 113:420

    PubMed  Google Scholar 

  36. Iyngkaran TM, Kanagalingam J, Rajeswaran R, Georgalas C, Kotecha B (2006) Long term results of laser assisted uvulopalatoplasty in 168 patients with snoring. J Laryngol Otol (in press)

Download references

Author information

Authors and Affiliations

  1. Royal National Throat Nose and Ear Hospital, 330/332 Grays Inn Road, London, WC1X 8DA, UK

    Edward Chisholm & Bhik Kotecha

Authors
  1. Edward Chisholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bhik Kotecha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bhik Kotecha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chisholm, E., Kotecha, B. Oropharyngeal surgery for obstructive sleep apnoea in CPAP failures. Eur Arch Otorhinolaryngol 264, 51–55 (2007). https://doi.org/10.1007/s00405-006-0139-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-006-0139-2

Keywords

Search

Navigation