[Effects of uvulopalatopharyngoplasty surgery on subsequent continuous positive airway pressure in patients with obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To determine the effect of uvulopalatopharyngoplasty (UPPP) therapy on post-surgery continuous positive airway pressure (CPAP) treatment during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to evaluate the use of Bi-level positive airway pressure (BiPAP) in whom CPAP therapy failed. METHODS: Thirty-four OSAHS patients after UPPP surgery were tested more than 3 months after the procedure. Among them 25 patients were treated with classical UPPP (cUPPP), in which all of the uvula and part of the soft palate were removed. Nine underwent modified UPPP (mUPPP), keeping part of the uvula. The control group consisted of 34 age, body mass index (BMI) and apnea hypopnea index (AHI) matched, newly diagnosed OSAHS patients without prior treatment. Four patients receiving both pre- and post-surgery tests were included in both groups. A manual titration of CPAP to determine the optimal CPAP pressure (oCPAP) and the highest CPAP pressure (hCPAP) the patient can tolerate was performed during both NREM and REM sleep in all 68 patients. RESULTS: 72% of the UPPP patients had less than 50% decrease in AHI, and 82% of the 34 patients still had AHI > 15 during post-operation PSG test. Hence, most of them needed further therapy. All of the untreated OSAHS patients could tolerate 17-20 cm H2O of CPAP during NREM and REM sleep. None had severe mouth air leak before an oCPAP was reached. In contrast, five in the surgery group failed to respond to CPAP treatment during both NREM and REM sleep, and one more during REM sleep. All of the nine patients who had a mUPPP could tolerate CPAP. One of the four tested both before and after surgery failed to respond to CPAP treatment after surgery during REM sleep and one during both NREM and REM sleep. However, the six patients failed to respond to CPAP treatment tolerated BiPAP therapy well. CONCLUSIONS: In a considerable number of patients with OSAHS, UPPP may compromise the applicability of nasal CPAP as a subsequent therapy, and BiPAP might be a treatment option for patients who could not tolerate CPAP treatment.

[Comparison of tolerance to sequential continuous positive airway pressure therapy between patients after classical and after modified uvulopalatopharyngoplasty].

OBJECTIVE: To investigate the effect of uvulopalatopharyngoplasty (UPPP) on postoperation continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: 66 OSAHS patients underwent UPPP were recruited and all were followed up for more than 12 months. Among them 24 patients were treated with classical UPPP, 42 had modified UPPP treatment. The efficacy of surgery was compared between the two groups. The post-operation tolerance to CPAP pressure was tested during sleep CPAP titration in 24 classical UPPP patients and in 15 modified UPPP patients. RESULTS: The validity ratio is 58.3% and 61.9% 12 months after operation. There was no significant difference between classical UPPP and modified UPPP in regard to surgery efficacy, and most of them need further CPAP therapy. During CPAP treatment, compared with untreated OSAHS patients, the highest CPAP pressure classical UPPP group could tolerant decreased significantly, however, classical UPPP group did not. 16.7% of classical UPPP patients had severe mouth air leak before optimal CPAP pressure was titrated, but none of the 15 post modified UPPP failed to sequential CPAP therapy. CONCLUSION: The efficacy was similar between modified UPPP and classical UPPP treatment, post modified UPPP patients had better tolerance to sequential CPAP treatment. It may be better to treat OSAHS patients with modified UPPP instead of classical UPPP.