Late term anatomical and functional (Polysomnographic) findings of patients who had undergone uvulopatopharyngoplasty for snoring and obstructive sleep apnea.

ObjectiveThe aim of this study is to determine late findings of patients who had undergone UPPP in our clinic, to reveal relevancy of these findings with anatomical changes, to examine the clinical efficacy of modifiable and unmodifiable factors involved in OSAS etiology and relevant measurements.Material and MethodThe study included 21 patients who had witnessed apneas and a body mass index < 35 kg/m2 during presentation, who had undergone modified uvulopalatopharyngoplasty (UPPP) in Celal Bayar University Faculty of Medicine, Ear, Nose and Throat Clinic with the diagnosis of sleep related breathing disorder between January 2005 and December 2008. Their demographic data, height and weight information, the Epworth Sleepiness Scale scores, whether they have craniofacial abnormalities, their nasal cavity and oropharynx examinations, flexible nasopharyngoscopic studies (including the Müller maneuver) were recorded. During the examination, also neck circumference, maximum mouth opening, mandibula - thyroid cartilage distance, mandibula - sternum distance, width and length of uvula, the upper alveolar arch width, palatal height, the distance between posterior edge of hard palate and the root of the uvula, distance between uvula/soft palate to posterior pharyngeal wall and distance between base of tongue to posterior pharyngeal wall as with flexible nasopaharygoscopy measurements were done. Full night polysomnographic recordings of patients were done with a comprehensive portable polysomnography equipment. Nine patients underwent computed tomography for the neck area.ResultsPatients were two women (9.5%) and 19 men (90.5%), age ranged from 35 to 71 (mean age 49,5). According to the PSG, there were 7 cases with AHI <5 events per hour, 11 cases with AHI <10 events per hour, 13 cases with AHI <15 events per hour and 15 cases with AHI <20 events per hour (33.3%, 52% 3, 61.9%, 71.4% respectively). Cases were grouped by AHI; age, body mass index, Epworth Sleepiness Scale score, time between surgery and the PSG, neck circumference findings were not significantly differrent between groups.Patients were also categorized according to AHI value of 15 events per hour or 20 events per hour. Uvula length, contrary to expectations, was statistically significantly longer in AHI 0-15 events per hour group (p = 0,013). In the same group, the mandible - thyroid distance is significantly longer than it is in AHI> 15 events per hour group (p = 0,014). Both in AHI 0-15 events per hour group and in AHI 0-20 events per hour group, the upper alveolar arch width (p = 0,001 and p = 0,027 respectively) and palatal height (p = 0,053 and p = 0,072 respectively) were significantly longer than the other groups they were compared. Another noteworthy finding is, shorter retrolingual distance is determined in AHI 0-15 events per hour group and AHI 0-20 events per hour group (p = 0.159 and p = 0.044 respectively).Contrary to expectations; retrolingual distance and minimum oxygen saturation and mean oxygen saturation was negatively correlated. There were negative correlations between neck circumference and maximum mouth opening and between mandibular - thyroid distance and minimum oxygen saturation. The upper alveolar arch width and the retropalatal distance measurements which were done through examination appears to be correlated with tomographic findings. But there is no correlation between the retrolingual distance measurement and tomographic measurements.ConclusionFactors which are not modifiable with UPPP are found to be effective on UPPP result. Rather than factors associated with soft tissue, skeletal-related factors may be associated more closely with the degree of OSAS. As the polysomnographic examinations which are the gold standard, is not sufficiently accessible due to cost and time in nature, parameters that reflect the skeletal structure which can be determined by examination could be useful for practical approach. For determining the place of obstruction which is very important for UPPP success, inclusion of skeletal structure measures to practically applicable examination methods could be useful. Studies with larger groups are needed be done to determine the threshold values.With UPPP, to obtain a certain oropharynx standard postoperatively is also aimed. When soft palate characteristics, retropalatal collapse rates with Müller maneuver and retropalatal distance data of patients were evaluated; this goal was thought to be achieved.AHI is not reduced in case of short uvula length or short distance between hard palate - uvula root. More resection of the soft palate and the uvula during UPPP, was thought not to provide additional benefit and may also result in complications such as velopharyngeal insufficency and mouth leakage which occurs during CPAP usage.