Effectiveness of tonsillectomy with (uvulo) palatopharyngoplasty in obstructive sleep apnea - a treatment option even for high-grade OSAS?

Introduction With appropriate findings, surgical therapy in the pharynx may be useful, especially in young patients with OSAS as an alternative to nocturnal breath therapy. However, according to the guideline, this is only recommended for lower severity levels. The aim of this study was to evaluate the effectiveness of bilateral tonsillectomy with uvulopalatopharyngoplasty (TE / UPPP) depending on the severity of OSAS.

Material and methods: The retrospective evaluation of the pre- and postoperative polysomnographies as well as the ESS of 139 patients (124m, 15w), who received a TE / UPPP between 06/2006 and 11/2018 (150 M), was done with the Wilcoxon test. The patients were grouped according to AHI into groups with mild (AHI 5-14, n = 55), moderate (AHI 15-29, n = 58) and severe OSAS (AHI> 30, n = 26).

Results In average, at time of surgery the age was 45 years and the BMI 28. The mean follow up was 4 months. The AHI was reduced from 11 to 7 in the group with mild OSAS (p = 0.529). In the group with moderate OSAS the AHI could be significantly reduced from 19 to 12 and with severe OSAS from 45 to 14 (p  < 0.05). Overall, the ODI was not significantly reduced by the OR: 9 to 6, p = 0.062. The snoring fraction was significantly reduced from 8.4 % to 4.5 % (p = 0.029). The ESS remained stable and showed no significant difference.

Discussion The TE / UPPP was able to lower the AHI by 36 % on mild OSAS, by 37 % in the moderate and by 69 % in the case of severe OSAS. Contrary to the guideline recommendation, in this study a TE / UPPP was able to effectively lower the AHI even with severe OSAS. Whether further therapy is needed should be evaluated afterwards.

Publication History

Article published online:
10 June 2020