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Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7084.851 (Published 22 March 1997) Cite this as: BMJ 1997;314:851

Isolated UPPP has been shown to have limited success for treatment of OSA patients

The goals of the treatment of obstructive sleep apnea (OSA) should be
aimed at alleviating symptoms while decreasing morbidity and mortality in
a manner that minimizes side effects.

Isolated UPPP has been shown to have limited success for treatment of
OSA patients. In comparison, palatal procedures combined with other
surgical approaches that address the multiple sites of obstruction in the
upper aerodigestive tract seem to have improved success in the carefully
selected patient.

Many surgical procedures have been described during the last 20
years [1]. The uvulopalatopharyngoplasty (UPPP) first described in 1981 by
Fujita et al [2], continues to be the mainstay. Since its introduction,
there has been considerable effort expended studying the efficacy of this
procedure and the role that it should play in the management of OSA.
Unfortunately, the results of these studies have shown that UPPP as an
isolated intervention for the treatment of OSA has met with mediocre
results.

Sher et al [3] have shown that UPPP is effective in only
approximately half of the cases of OSA when success is defined as a drop
in the AHI by 50%. When more stringent criteria are used-absolute decline
in the apnea index to less than 10 or an AHI less than 20-the success rate
is lowered to 40.7% [3].

Sincerely

References

1. Sher AE. Upper airway surgery for obstructive sleep apnea. Sleep
Med Rev. 2002 Jun;6(3):195-212.

2. Fujita S, Conway W, Zorick F, Roth T. Surgical correction of
anatomic abnormalities in obstructive sleep apnea syndrome:
uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981 Nov-
Dec;89(6):923-34.

3. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical
modifications of the upper airway in adults with obstructive sleep apnea
syndrome. Sleep. 1996 Feb;19(2):156-77.

Competing interests:
None declared

Competing interests: No competing interests

31 October 2005
Murat Enoz
Specialist
Department of Otolaryngology, Head&Neck Surgery, Istanbul University, School of Medicine, Turkey