CHICAGO (Reuters Health) - A surgical procedure virtually resolves obstructive sleep apnea in about one third of patients and reduces the need for continuous positive airway pressure (CPAP) in others.
Surgeons at the Mayo Clinic report long-term success with a surgery called uvulopalatopharyngoplasty (UPPP), in which excess tissue around the tonsils, uvula and soft palate is removed and in some cases soft rods are placed in the upper palate.
Researchers presented their 7-year findings here at CHEST 2007, the annual assembly of the American College of Chest Physicians.
Principal investigator Dr. Akram Khan and colleagues described results in 63 patients with obstructive sleep apnea between the ages of 18 and 80 years at the time of surgery. Average age was 42 years and average body mass index was 33.7, indicating obesity.
UPPP has resulted in an average reduction of the apnea-hypopnea index, a measurement of airflow and active breathing during sleep, from 62.6 before surgery to 28.3 after surgery, Khan reported. Twenty-one patients had an apnea-hypopnea index of 10 or less.
Respiratory-related arousals, or apnea-related awakenings from sleep, decreased by 27.5 percent. The arousal index decreased from 58.3 at the beginning of the study to 35.9 at follow-up, for a 38.7-percent reduction. The length of time oxygen saturation levels were below 90 percent dropped from 25.8 percent to 15.9 percent.
Subjective reports of snoring also improved from 2.9 to 2.2 (on a 4-point scale) when lying face up and from 2.7 to 1.7 when lying on the side. These changes are statistically significant, Khan said.
Of the patients who still had some signs of sleep apnea, 35 were able to reduce the amount air pressure and 7 no longer needed the CPAP device.
"UPPP improves but usually does not completely resolve obstructive sleep apnea," Khan concluded. "For those with residual obstructive sleep apnea following UPPP who return to CPAP, pressure requirements will be modestly lower. The clinical significance of this observation is not clear."
