Unpredictable results of laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnoea

Abstract

Background: Laser assisted uvulopalatoplasty (LAUP) is increasingly offered for the treatment of obstructive sleep apnoea (OSA), although there is a lack of objective data to support its indications and efficacy. A study was undertaken to determine the treatment response to LAUP. Methods: Overnight polysomnography was performed before and at least three months after surgery in 44 consecutive patients with symptomatic mild to moderate OSA (apnoea + hypopnoea index (AHI) > 10/h). Pharyngeal dimensions were measured by videoendoscopy (n = 11) and disease-specific quality of life, sleepiness and snoring frequency (n = 16) before and after surgery were determined in subgroups of patients. LAUP was performed under local anaesthesia as a one stage resection of the uvula and soft palate by one of two experienced otolaryngologists. Results: Twelve patients (27%) had a good response (AHI ≤ 10/h after LAUP); four (9%) had a partial response (AHI ≤ 50% of pre-LAUP value); 15 (34%) had a poor response (AHI > 50% of pre-LAUP value); and 13 (30%) patients were worse (AHI > 100% of pre-LAUP value). The velopharyngeal cross sectional area and anteroposterior diameter increased following LAUP (p < 0.05). Quality of life indices improved significantly in all domains and sleepiness decreased. The snoring index did not decrease significantly. No preoperative anthropometric or videoendoscopic measures were predictive of a good response to LAUP. Patients who were worse after LAUP had milder baseline apnoea severity than those in the other response groups. Conclusions: The treatment response to LAUP is variable and unpredictable, and only a few patients achieve a satisfactory response. There appears to be no relationship between subjective and objective measures of treatment efficacy.