Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome?

Objectives: Uvulopalatopharyngoplasty (UP3) is the single most commonly performed surgical procedure for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS), but its success is limited. Our objective was to determine whether severity of disease of OSAHS based on polysomnography (PSG) data (apnea/hypopnea index [AHI]) is a significant factor in predicting successful treatment by UP3. In addition, we compared anatomic staging with severity of disease to determine which is the better predictor of success.

Study Design: A retrospective chart review of 134 patients who underwent UP3 as an isolated procedure for the treatment of OSAHS in a tertiary university-affiliated medical center.

Results: Forty-five patients had mild disease with an AHI less than 20. The surgical success rate (defined as a 50% reduction in AHI and a postoperative AHI of < 20) was 26.7%. There were 40 patients with moderate disease (AHI 20-40) who had a surgical success rate of 42.5%. There were 49 patients with severe disease (AHI < 40) with a surgical success rate of 26.5%. The same patients were analyzed by the Friedman Staging System using anatomic findings without incorporating the severity of disease. Results indicated the following. Stage I had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III had a success rate of 8.1%. Assessment of severity within each stage did not affect outcome.

Conclusions: Patients with mild disease based on PSG data do not have a better chance of successful treatment than patients with severe disease. Severity of disease should not be incorporated in the staging system. The Friedman Staging System based on anatomic factors is superior to severity of disease as a predictor of successful UP3.