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Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective
Author(s) -
Steffen Armin,
Abrams Nils,
Suurna Maria V.,
Wollenberg Barbara,
Hasselbacher Katrin
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27357
Subject(s) - uvulopalatopharyngoplasty , medicine , obstructive sleep apnea , airway , airway obstruction , apnea , hypopnea , anesthesia , surgery , polysomnography
Objective Upper airway stimulation (UAS) is an effective second‐line treatment for obstructive sleep apnea (OSA). In certain patients, there is a considerable need for advanced programming, notably with inadequate palatal response to therapy. The aim of the study was to investigate the impact of uvulopalatopharyngoplasty and tonsillectomy (UPPP‐TE) on UAS therapy outcomes from a 2‐year perspective after implantation. Methods This study included all consecutive patients implanted with UAS in which a full set of 1‐ and 2‐year follow‐up assessments (M12 and M24) were obtained. Cases were analyzed in three groups: patients with UPPP‐TE after (group 1) and before (group 2) UAS, and those without UPPP‐TE (group 3). Results Therapy success could be achieved in about 80% of the entire cohort. Groups 2 and 3 did not differ significantly with regard to obesity, Apnea‐Hypopnea Index, or Oxygen Desaturation Index. With regard to initial sleep endoscopy, there were fewer patients without any obstruction at the palatal and oropharyngeal levels and higher prevalence of lateral obstruction patterns at oropharynx in group 1 in contrast to groups 2 and 3. Groups 2 and 3 showed similar results, although group 2 patients underwent UPPP‐TE before UAS implantation. Conclusion UPPP‐TE should be considered in patients with persistent OSA after UAS implantation if the obstruction is identified at the level of velum and oropharynx. Although this approach has higher response rates and better outcomes can be achieved in patients with UAS, there is no indication for patients to routinely undergo UPPP‐TE prior to UAS implantation. Level of Evidence 4 Laryngoscope , 129:514–518, 2019