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Sleep Care

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OSA Treatment: UPPP Surgery

For most people, treating their sleep apnea involves the use of Continuous Positive Airway Pressure (CPAP), weight loss, and possibly positional sleep therapy if their apnea is restricted to certain positions, such as when they’re lying on their back. While these are often “first-line” treatments to consider, another option is a surgery called a Uvulopalatopharyngoplasty, more commonly known as UPPP.

What is UPPP?

UPPP is a surgery that was developed in 1981 and became popular as an alternative treatment for sleep apnea for patients who had difficulty tolerating CPAP (a technology that was not as advanced back then as it is now). It is the most common surgical procedure used today in treating sleep apnea, although variants of it have been developed over the years to address some of its shortcomings. A UPPP involves removing the tonsils, the back part of the soft palate, and the uvula (a tear-shaped piece of tissue that hangs down at the back of the throat). The goal is to widen the airway, making it less likely for it to collapse or partially collapse and cause the problems commonly associated with sleep apnea.

Is UPPP Effective?

Studies investigating the success of UPPP in treating sleep apnea have generally yielded mixed results. UPPP does appear to be effective in eliminating snoring for most individuals, but controlling sleep apnea tends to be more difficult. According to a 2010 review of studies done on UPPP’s effectiveness, the apnea-hypopnea index (AHI; a term used in describing the severity of a person’s sleep apnea) is lowered by 33% for those undergoing the

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procedure, although their overall AHI remained unacceptably high for their sleep apnea to be considered adequately treated. It is not uncommon for apnea to remain or return in UPPP patients, requiring the use CPAP machine to completely eliminate apnea symptoms. Despite these objective findings, patients who have undergone a UPPP often report improvement in their snoring, daytime sleepiness, and overall quality of life.

Who is a Good Candidate for a UPPP?

Evaluation for a UPPP procedure is usually done by an Ear, Nose, and Throat (ENT) surgeon. It is common to have an overnight study done in a sleep lab (if it hasn’t been done already) to establish the severity of a person’s sleep apnea. Because CPAP tends to be more effective in resolving sleep apnea for most people than a UPPP, a trial of CPAP is usually recommended before having the surgery.

Initially, the severity of a person’s sleep apnea was used as an indicator for a UPPP. According to the American Academy of Sleep Medicine’s guidelines for surgical treatment of obstructive sleep apnea (OSA), procedures like a UPPP are generally most effective for patients with mild sleep apnea and not reliable for treatment in patients with moderate or severe OSA. Research aiming to more accurately pinpoint the best candidates for success with UPPP have found that factors such as pre-operative tonsil size, position of the tongue and palate, a person’s Body Mass Index (BMI), and the angle to which their mouth opens can be important predictors as well.

What Are the Side Effects of UPPP?

Patients who have undergone a UPPP will almost unanimously agree that it is a challenging procedure to recover from. UPPP is considered to be a very painful procedure taking as many as ten days to fully recover from. The specific risks and side effects of a UPPP are something to review with an ENT surgeon when considering the procedure. Some of the more common side effects include difficulty swallowing, taste disturbances and voice changes.

 

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