Clinical Predictors for Successful Uvulopalatopharyngoplasty in the Management of Obstructive Sleep Apnea

Objective. To assess the clinical parameters for successful uvulopalatopharyngoplasty in the management of obstructive sleep apnoea syndrome documented with pre- and postoperative polysomnography. Materials and Methods. A study group of 50 patients diagnosed as having OSA by full night polysomnography were assessed clinically and staged on basis of Friedman staging system. BMI and neck circumference were considered, and videoendoscopy with Muller’s maneuver was done in all to document the site of obstruction. The study group divided into surgical and nonsurgical ones. Twenty-two patients out of fifty were then selected for uvulopalatopharyngoplasty. The selection of surgical group was done primarily on basis of clinical parameters like neck circumference, Friedman stage of the patient and site, and/or level of obstruction of patient. Postoperative polysomnography was done six months after surgery to document the change in AHI score. Result. The study group consists of fifty patients with mean age of years. UPPP was done in twenty-two, and the result of the surgery as defined by 50% reduction in preoperative AHI with postoperative AHI < 20/h was seen to be 95.2%. Postoperative change in AHI done after 6-month interval was seen to be statistically significant with P value < 0.001. Conclusion. UPPP is ideal option for management of obstructive sleep apnoea syndrome in properly selected patients on the basis of Friedman stage and site of obstruction detected by videoendoscopy with Muller’s maneuver. 1. Introduction Obstructive sleep apnea (OSA) is a common condition, affecting 4% of men and 2% of women [1]. Currently the condition is diagnosed by history, physical examination, imaging studies, and polysomnography. Common symptoms of the condition have limited predictive value in identifying patients with OSA. The upper airway is the main anatomical site responsible for OSA. Clinical examination may point to severe retrognathia, hypertrophic tonsils, macroglossia and redundant pillars, elongated uvula, and a crowded oropharynx [2]. Endoscopic investigations have been performed in awake as well as in sleeping patients, with the pharynx in relaxed or active states, but their predictive value remains limited, both for diagnostic purposes and for identifying patients who may benefit from surgery [3]. The otolaryngologist has the unique opportunity to examine the palate, pharynx, and neck of the patient and suspect OSA when appropriate. Diagnosis of a disease is based on clinical symptoms and physical findings and is corroborated by laboratory examinations.