The role of UPPP in Upper-Airway Stimulation for patients with Obstructive Sleep Apnea (OSA) – Tailoring outcomes?

Introduction:

Upper airway stimulation (UAS) is an established second line therapy in patients with OSA and CPAP failure. Despite several options of impuls and electrode configuration, therapy response rates vary. If the underlying cause is composed of insufficient opening of the soft palate obstruction, soft palate surgery and tonsillectomy (UPPP-TE) might provide a remedy.

Materials and methods:

Ten patients who did not sufficiently respond to UAS, despite several attempts of therapy optimization, were included into this analysis (group 1). Patients were followed for two years after hypoglossal nerve stimulator (HNS) implantation. After confirmed inadequate soft palate opening in renewed sleep endoscopy (DISE) with stimulated upper airway, patients underwent UPPP-TE. Two comparison groups were examined: group 2 (n = 10) consisted of patients, who had previously undergone soft palate surgery, group 3 (n = 6) of patients that never received intervention on the soft palate level.

Results:

The average AHI of group 1 was reduced from 46,1/h to 35,2/h after HNS implantation. After UPPP-TE, AHI decreased to 23,7/h (12 mo) respectively 11,9/h (24 mo). In group 2 and 3, average AHI decreased from 26,6/h to 8/h and from 27,5/h to 6,5/h at one year of follow-up, respectively. Results remained constant at two year follow up. Average initial AHI and BMI were higher for group 1 than for both comparison groups.

Conclusion:

In case of insufficient UAS success and confirmed remaining soft palate obstruction, UPPP-TE can provide long-term therapy improvement. However, reciprocally it is not shown that UPPP-TE should be performed beforehand to guarantee therapy success. DISE with active upper airway stimulation and long-term aftercare should be given special importance in this context.

Publication History

Publication Date:
18 April 2018 (online)