Prediction of uvulopalatopharyngoplasty outcome: Anatomy-based staging system versus severity-based staging system

Abstract

Study Objective: To evaluate and compare outcomes of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea/hypopnea syndrome (OSAHS) using anatomy- and severity-based staging systems. Design: Prospective design with a retrospective review. Setting: A tertiary-care, sleep disorder referral center. Patients: In total, 110 patients with OSAHS (105 men, 5 women; mean age, 43 years; apnea-hypopnea index, 44.4 ± 28.8 events per hour; body mass index, 27.1 ± 3.3 kg/m2). Measurements: An anatomy-based staging system (stages I-IV) was used to classify patients with OSAHS by examining tongue-palate position, tonsil size, body mass index, and craniofacial deformities. Patients were also classified as having mild, moderate, moderate-severe, or severe OSAHS based on preoperative apnea-hypopnea index from polysomnography (a severity-based staging system). Surgical success was defined as a 50% or greater reduction in the apnea-hypopnea index and a postoperative apnea-hypopnea index of less than 20 events per hour. Intervention: UPPP was performed in all patients. Results: The overall success rate of UPPP was 78%. Success rates for mild (90%), moderate (73%), moderate-severe (81%), and severe (74%) diseases were similar (p = .10). Conversely, success rates for patients with anatomy-based stages I, II, III, and IV were 100%, 96%, 65%, and 20%, respectively; these rates were significantly different (p < .001). Changes in apnea-hypopnea index were significantly correlated with Friedman tongue position (FTP)(r = -0.33, p = .0004) and tonsil size (r = -0.37, p < .0001). The FTP (odds ratio = 0.43, SE = 0.13, p = .005, 95% confidence interval = 0.24-0.78) and tonsil size (odds ratio = 3.13, SE = 1.53, p = .02, 95% confidence interval = 1.20-8.17), but not the severity-based staging (odds ratio = 0.77, SE=0.18, p = .283, 95% confidence interval = 0.49-1.23), were predictive of surgical success. Conclusion: The anatomy-based staging system predicted UPPP outcomes more effectively than did the severity-based staging. The anatomy-based staging system facilitates good case-selection information for counseling patients before UPPP surgery.