Success predictors in uvulopalatopharyngoplasties for the treatment of Obstructive Sleep Apnea syndrome

• Published in: Sleep medicine Vol. 14; p. e81
• Main Authors: Braga, A, Valera, F, Eckeli, A, Kupper, D, Grechi, T, Trawitzky, L
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-12-2013
• Subjects: Neurology; Sleep Medicine
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2013.11.166

Introduction Obstructive Sleep Apnea syndrome ( OSAS ) has many treatment options clinical and surgical, all of them having your own successful index. Uvulopalatopharyngoplasty (UPPP) is described as a surgical treatment option to treat this disease. This disease, with variable reported results. The influence of facial bony and muscular structures on this rate of success has been poorly reported in literature. The muscular dysfunction is discussed and its influence on the failure of the treatment options. Materials and methods Patients have undergone UPPP for the last 7 years have enrolled this study. Inclusion criteria included full clinical evaluation, including body mass index and age at the moment of surgery and pre and post-operative polysomnography (PSG). They were also submitted to lateral cephalometry to evaluate 11 skeletal measures, a clinical myofunctional protocol and muscular strength force. Patients were divided into two groups, based on AHI (apnea and hypopnea index): those with UPPP success and those that failed with UPPP treatment. Results The rate of success of UPPP was not influenced by the measures age, BMI, pre-operative AHI and any of the cephalometric measures. Among the muscular evaluations, the muscle strength of the tip of tongue was significantly different between the groups. All the other measures were similar between groups. Conclusion We may consider OSAS having a multifactorial origin and the interaction of them playing role on the syndrome and its possibility on failure of the treatment. Neural and muscular dysfunction may have influence on the low rates of surgical success presented and its progressive decrease with the time even after surgical alternatives being considered. Our results showed muscular damage in the group that showed failure in polissonographic evaluation after surgery. OSAS giving dilator muscle dysfunction may be considered as one of responsible for the failure of the treatment and a possible progression on the severity of the disease after time. OSAS has a multifactorial origin, and depends on the combination of various factors rather than an isolated one. It is still difficult to predict the patient that will have a better outcome on UPPP, based on simply clinical and radiological factors but muscular damage and its progression must be considered when patients is evaluated for all kinds of treatments proceed, surgical or not. Acknowledgements University of São Paulo, School of Medicine of Ribeirao Preto – correlated authors – hospital employees – professors – assistent doctors – patients.