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29-01-2012 | Psychology | Article

Novel surgical technique has high success rate in OSAS patients


Free abstract

MedWire News: A novel modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of patients with obstructive sleep apnea syndrome (OSAS) is associated with high success rates, say Japanese researchers.

Ichiro Komada (Shiga Hospital of Social Insurance) and colleagues explain that "UPPP… has gained widespread use for the surgical treatment of patients with OSAS. However, the reported success rates of only 30-65% are insufficient."

They add: "Many modifications of UPPP have been reported, but the results remain inadequate. Unexpected scar formation and inappropriate selection of patients for surgical treatment may contribute to these poor success rates."

For the current study, the team investigated the effectiveness of a new surgical UPPP technique, called two-piece palatopharyngoplasty (Two-P4), for the treatment of OSAS.

"Two-P4 keeps the middle soft palate intact to form independent scars on both sides, which constrict to stretch the soft palate and widen the pharyngeal space," explain the researchers.

They studied 24 patients (mean age 40.8 years) with mild to severe OSAS who underwent Two-P4 between 2002 and 2007. Of these, 10 were classified as Friedman's anatomic stage I, nine as stage II, and five as stage III.

All of the participants were assessed using polysomnography and scores on the Epworth Sleepiness Scale and Apnea-Hypopnea Index (AHI) were determined before and 3 months after surgery. Surgical success was defined as achieving at least a 50% reduction in AHI scores and a postoperative AHI score of less than 20.

Overall, mean AHI score improved from 50.9 before to 10.7 after the procedure, and mean ESS score decreased significantly from 13.0 to 7.7.

Surgical success was achieved in 91.7% (n=22) of patients, with mean reductions in AHI scores of 86.2% in Friedman's anatomic stage I patients, 78.9% in stage II patients, and 54.5% in stage III patients.

Komada and colleagues conclude in Auris Nasus Larynx: "Two-P4 is a novel surgical treatment for OSAS patients with a high success rate (91.7%) as evaluated by reductions in AHI."

They add: "Patients with Friedman's stage I and II represent the best indications for this surgery."

By Mark Cowen

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