ChicagoGranny wrote:I had the same question when I first read your comment, Den.DeepFriedDuck wrote:I'd like to see a reference to this statement.Wulfman... wrote:The OSA will typically come back
I personally know several people who had UPPPs that turned out to be only partially effective at best. They knew it as soon as the surgery healed - shown by sleep studies or oximetry studies or wives telling them they still snored heavily.
But here, you say something different - "will ... come back".
What's this "come back" stuff? You are saying they are free of OSA and then it comes back? That's the way I read it and it is something I never heard of and it is not in the threads you provided.
Maybe you were just posting sloppily and meant UPPP "typically is not a cure".
NO and NO.......I'm just reporting what I've read. I KNOW it's not a "cure" for the vast majority of people. Some people THINK they have been "cured" by having the surgery only to have the OSA return IN SOME MANNER in the future. Maybe they got a reduction in their OSA and FELT like they could quit therapy or some other conditions were not addressed when they had the surgery (like nasal surgeries) and they had false hope. But, I have read that some people returned to XPAP therapy after about 6 months.
I've never had that procedure, although my sleep doctor made some vague comments suggesting I may need something like that if my prescribed pressure of 18 cm. wasn't going to do the job.
I think it depends on the person and the surgeons performing the surgery.......when it was done (years ago or recent times) and maybe a few other factors.
But, from my readings of posts on the forum by those who have had it done, it seems to either be that the procedure is:
somewhat effective for about 6 months,
or 50% effective for lowering the person's therapy pressure,
or in some cases, the person needs even higher pressure and bi-level therapy.
In other words, the results are all over the place, but I don't recall reading that ANYONE has been "cured" of OSA by having it done.
All a person has to do is read through the links in the search link I posted earlier.
But, here are two of them to some clinical reports.
Den
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http://umm.edu/health/medical/reports/a ... leep-apnea
Uvulopalatopharyngoplasty (UPPP)
The Procedure. Surgery known as uvulopalatopharyngoplasty (UPPP) removes soft tissue on the back of the throat. Such tissue includes all or part of the uvula (the soft flap of tissue that hangs down at the back of the mouth) and parts of the soft palate and the throat tissue behind it. If tonsils and adenoids are present, they are removed. The surgery typically requires a stay in the hospital.
The Goal of Surgery. The goal of UPPP is threefold:
Increase the width of the airway at the throat's opening
Block some of the muscle action in order to improve the ability of the airway to remain open
Improve the movement and closure of the soft palate
Success Rates. The American Academy of Sleep Medicine does not endorse UPPP as a sole procedure for treating OSA. The AASM recommends that patients considering this surgery first try CPAP or dental devices.
There is limited evidence as to the effectiveness of UPPP. Studies suggest that success rates for sleep apnea surgery are rarely higher than 65% and often deteriorate with time, averaging about 50% or less over the long term. Few studies have been conducted on which patients make the best candidates. Some studies suggest that surgery is best suited for patients with abnormalities in the soft palate. Results are poor if the problems involve other areas or the full palate. In such cases, CPAP is superior and should always be tried first. Many or most patients with moderate or severe sleep apnea will likely still require CPAP treatment after surgery.
Complications. Uvulopalatopharyngoplasty is among the most painful treatments for sleep apnea, and recovery takes several weeks. The procedure also has a number of potentially serious complications including:
Infection
Impaired function in the soft palate and muscles of the throat (called velopharyngeal insufficiency), which can make it difficult to keep liquids out of the airway
Mucus in the throat
Changes in voice frequency
Swallowing problems
Regurgitation of fluids through the nose or mouth
Impaired sense of smell
Failure and recurrence of apnea. In such cases, CPAP is often less effective afterward.
In general, only a small percentage of patients experience serious complications. Many of these complications can be avoided with proper technique and experienced surgeon. A patient's health status, including presence of obesity and other health conditions, may also affect outcomes.
Laser-Assisted Uvulopalatoplasty (LAUP)
A variation on UPPP called laser-assisted uvulopalatoplasty (LAUP) is being increasingly performed to reduce snoring. It removes less tissue at the back of the throat than UPPP and can be done in a doctor's office. At this time, however, long-term success rates in the treatment of obstructive sleep apnea with LAUP are very modest, particularly for reducing apneas. Some doctors, in fact, are concerned that if LAUP eliminates snoring, they may miss a diagnosis of apnea in patients who have the more serious condition.
More than half of patients complain of throat dryness after surgery. Throat narrowing and scarring have also been reported. In a minority of patients, snoring becomes worse afterward.
According to recent guidelines from the American Academy of Sleep Medicine (AASM), LAUP is not routinely recommended as treatment for obstructive sleep apnea. According to the AASM, this surgery generally does not help improve symptoms and may actually worsen the condition.
Source: Obstructive sleep apnea | University of Maryland Medical Center http://umm.edu/health/medical/reports/a ... z3kuagWzR7
University of Maryland Medical Center
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http://www.hindawi.com/journals/ijoto/2013/290265/
4. Discussion
Uvulopalatopharyngoplasty is the most common surgical procedure performed for the management of OSAS, but the success rate and the role of UPPP in the management of OSA remain unclear because most studies are limited by small sample size, lack of consensus on a clear definition of surgical success, and an inability to compare UPPP in a blinded manner with CPAP [1, 2, 7]. The main goal of this study was to redefine the ideal clinical parameters to identify those patients with high likelihood of successful UPPP and separate them from those with high likelihood of failure, thus guiding patient selection and improving outcome. Traditionally, a successful outcome of UPPP has been defined as achieving a reduction in AHI of at least 50% and/or a residual AHI of 20 or less. The study format analysing clinical parameters like neck circumference, level/site of obstruction in addition to BMI, tonsil grade, and Friedman palatal position have augmented the guiding criteria for improving the successful result of UPPP in the management of OSAS. Friedman stage I and II were considered for surgery, and stage III was compared as nonsurgical group. Friedman stage was also seen to be significantly correlated with the AHI severity of patient, so the patients in the surgical group were having lesser severity of disease on the basis of AHI as compared to the nonsurgical group. The neck size and BMI of patients in surgical group were seen to be significantly less as compared to nonsurgical group [7, 11, 12]. On the basis of site of obstruction as seen with videoendoscopy with Mueller’s manoeuvre, patients with retropalatal and retrolingual were only considered for surgery and all the hypopharyngeal and multilevel obstruction patients were excluded to increase surgical outcome rates. So the videoendoscopy is a complementary diagnostic tool that can be easily performed, especially for surgeons who need to know where and how the obstruction occurs [3, 7, 13]. The successful outcome of the surgery as defined by 50% reduction in preoperative AHI with postoperative AHI < 20/h was seen to be 95.2% as shown in Figure 4. In almost all previous studies done for UPPP, utmost 80% successful treatment outcome was achieved as in all these level/site of obstruction was neglected. As most of the patients have multilevel obstruction with hypopharyngeal as one of the component, UPPP that corrects retropalatal and retrolingual obstruction only is not sufficient treatment. This improved successful treatment goal with UPPP is possible only through proper selection of patients on merits of neck size and site of obstruction in addition to Friedman staging system [7, 8, 11, 13]. In addition, there was no craniofacial abnormality in our selected group, hypopharyngeal obstruction was not considered, and the sample size, once stratified, was relatively small. One of the strengths of the our study is the assessment of pre-UPPP and post-UPPP symptomatology changes in major symptoms as measured by working questionnaires which may strengthen interpretation of the surgical results. Significant changes were noted in major symptoms after surgery. While success rates are slightly higher than those published by Friedman and colleagues, the response seen with this anatomic staging system suggests that this is an effective method for stratifying surgical OSA patients for possible successful UPPP surgery.
5. Conclusion
This study redefines the clinical assessment parameters of OSAS patients for successful outcome of the UPPP. UPPP is a better option for management of obstructive sleep apnoea syndrome in properly selected patients on the basis of Friedman stage and site of obstruction detected by videoendoscopy with muller’s maneuver. All cases of obstruction at the palatal level can be addressed by UPPP with satisfactory success rate.
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