Snoring and sleep apnoeaBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6942.1509a (Published 04 June 1994) Cite this as: BMJ 1994;308:1509
EDITOR, - In his letter on the management of snoring Peter J Robb states that treatment by uvulopalatopharyngoplasty is associated with minimal morbidity and mortality in selected patients.1 This may not be the case.
Some “simple snorers” can develop sleep apnoea just by gaining weight, and others seem to develop sleep apnoea with advancing years for unrecognised reasons. In people with sleep apnoea obstruction occurs at either the retroglossal or the retropalatal level,*RF 2-4* and treatment with continuous positive airway pressure requires a seal between the soft palate, palatal arches, and tongue. Thus, after uvulopalatopharyngoplasty a patient who develops sleep apnoea with retroglossal obstruction may be untreatable by continuous positive airway pressure owing to loss of the palatal seal. The patient will therefore be at risk of the cardiovascular morbidity and death associated with sleep apnoea,5 as well as the increased risks associated with driving unless tracheostomy is performed.
Until more is known about the aetiology and natural course of sleep apnoea, operative treatment of snoring by uvulopalatopharyngoplasty even in selected patients may be associated subsequently with appreciable morbidity and death.