The efficacy of laser-assisteduvulopalatoplasty in the management of obstructive sleep apnea and upper airway resistance syndrome

Abstract

Laser-assisted uvulopalatoplasty (LAUP) is an effective method for treating patients experiencing loud habitual snoring. LAUP is reserved for patients with either simple snoring or mild sleep apnea. The procedure is performed in several stages in an ambulatory setting under local anesthesia using a CO₂ laser with a special handpiece. One major advantage of LAUP over uvulopalatopharyngoplasty (UPPP) is the ability to titrate tissue removal without the risk of overresection. We have achieved an 85% success rate for reduction or elimination of snoring in over 450 patients. Of our patients evaluated for snoring, 71% had polysomnography before surgical treatment. Various degrees of obstructive sleep apnea syndrome (OSAS) were found in most of these patients. The initial treatment of choice for moderate to severe OSAS is continuous positive airway pressure (CPAP). CPAP and weight control in conjunction with extended LAUP is the recommended long-term management. The primary reason for lack of response to LAUP in the management of OSAS is usually lingual tonsil hypertrophy. Laser surgery directed to the tongue base may be the preferred method of treatment for these patients, as opposed to skeletal advancement procedure. Upper airway resistance syndrome (UARS) can be managed by CPAP or surgery directed at the site creating the maximum resistance. Most commonly these procedures include LAUP and/or intranasal surgery. OSAS and snoring are ongoing disease processes. Snoring, once thought to be only a social problem, may actually be a precursor to subsequent OSAS, a concept that we are now prospectively studying. Therefore, patients with the diagnosis of OSAS and snoring must be followed up throughout their lifetime. Preliminary data from this study show a significant association between weight loss and the apnea index (AHI) regardless of the treatment used.