Long-term results in obstructive sleep apnea syndrome (OSAS) after laser-assisted uvulopalatoplasty (LAUP).

Önder Göktas,Mustafa Solmaz,Heidi Olze,Gökhan Göktas,Richard E. Burney

doi:10.1371/journal.pone.0100211

Önder Göktas, Mustafa Solmaz + Show 3 more

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https://doi.org/10.1371/journal.pone.0100211

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Journal: PloS one	Publication Date: Jun 30, 2014
Citations: 13	License type: CC BY 4.0

Affiliation: Charité - Universitätsmedizin Berlin

Abstract

Obstructive sleep apnea syndrome (OSAS) is a serious disease. The etiology of and optimum therapy options for this disorder have been much discussed and have been the subject of many publications. One much discussed therapy option is laser-assisted uvulopalatoplasty (LAUP). Despite conflicting opinions and guidelines which recommend that it should not be used, it remains in use. Patients who had previously undergone this procedure were invited for follow-up appointments, at which they were asked to complete a questionnaire, underwent an ENT examination and underwent sleep laboratory analysis using a portable sleep lab device. The average time since LAUP treatment was 11 years. The cohort comprised 25 patients. The average preoperative apnea-hypopnea-index (AHI) score was 25.25/h; the average postoperative AHI score 23.62/h. Closer examination of our data enabled us to identify 10 responders (40%) and 15 non-responders (60%). 12% (3/25) of non-responders experienced either no reduction in their AHI score or an increase compared to their preoperative AHI score of less than 5/h. In the remaining 48% (12/25), AHI increased by more than 5/h compared to the preoperative figure. Our questionnaire showed that 40% (10/25) of patients suffered from dry mouth and 20% (5/25) from foreign body sensation. The data led us to conclude that laser-assisted uvulopalatoplasty can indeed result in a reduction in AHI score comparable to other mucosal resection methods. Also in common with these methods, the efficacy of the therapy reduces with time and the procedure carries a high risk of bringing about an increase in the patient's AHI score.

Highlights

Obstructive sleep apnea syndrome (OSAS) is the most common sleep-related breathing disorder
Treatment of patients with obstructive sleep apnea syndrome is considered successful if the postoperative apnea hypopnea index (AHI) score is at least 50% lower than the preoperative score and less than 20/h
Polysomnography of our 25 patients an average of more than 11 years after Laser-assisted uvulopalatoplasty (LAUP) found that 28% (7) of the patients had been cured of their OSAS and that 12% (3 responders) had experienced a reduction in their apnea hypopnea index (AHI) score of more than 50% and had an AHI score #20/h

Summary

Introduction

Obstructive sleep apnea syndrome (OSAS) is the most common sleep-related breathing disorder. Laser-assisted uvulopalatoplasty (LAUP) is a much discussed option for surgical treatment of OSAS [2,3,4]. LAUP was first described in 1990 and is a mucosal resection technique [5]. In contrast to uvulopalatopharyngoplasty (UPPP), LAUP does not require the insertion of stitches and can be performed as an outpatient procedure. Like UPPP, LAUP has gone through a number of iterations over time and has been in use for the treatment of snoring and OSAS for several years. The procedure involves making bilateral vertical incisions in the para-uvular region of the soft palate. After making the incisions described above, only a portion of the uvula is resected in the parauvular region, such that the base of the uvula is retained (Figure 1) [6]. Neither technique involves tonsillectomy or the use of stitches [3,7,8,9]

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