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Objectives: This study aims to analyze trends in utilization and reimbursement of soft palate surgery for OSA using the Medicare national database. Methods: A retrospective analysis of the 2000 to 2021 Part B National Summery datafiles using current Procedural Terminology (CPT) codes 42145 (uvulopalatopharyngoplasty [UPPP]), 42950 (pharyngoplasty [PP]), and 42140 (uvulectomy [UVU]) was performed. Results: Between 2000 and 2021, the number of OSA surgeries fell 65.7% from 4208 to 1443. UPPP fell 87.6% from 3455 in 2000 to 428 in 2021 (P <.001). UVU also fell in popularity, from 568 to 376 (33.8%; P <.001). In contrast, the performance of PP rose 245.4% over time, from 185 to 639 (P <.001). When comparing 2000 to 2009, both PP and UVU rose in relative use (from 4.4% to 12.3% and from 13.5% to 20.4% of all soft palate OSA surgeries, respectively), while UPPP fell (82.1% to 67.3%; P <.001). Total Medicare payments for all 3 procedures fell 57.2% from $1 658 844 to $633 091 (P <.001). Adjusted total UPPP payments fell 88.7% (P <.001). Adjusted total PP payment rose 137.5% to $262 538 in 2021 (P <.001). Conclusion: Soft palate surgery for OSA has declined amongst the Medicare population over 21 years (2000-2021). The more individualized and tissue sparing PP has risen in popularity but did not overcome the large decline of the traditional UPPP. Accordingly, there was a 75.7% fall in inflation-adjusted reimbursements. Overall, our data indicates a decline in soft palate surgery in the management of geriatric OSA, with modest relative increase in pharyngoplasty procedures. [ABSTRACT FROM AUTHOR]

Pycnodysostosis (PDS) is an autosomal recessive form of osteosclerotic skeletal dysplasia characterized by craniofacial anomalies, a high-arched palate, and a narrowed pharyngeal space due to mandibular and maxillary deficiencies. These structural anomalies in the upper airway predispose PDS patients to obstructive sleep apnea (OSA). OSA can be managed in PDS patients using either a conservative (non-surgical and multidisciplinary) approach or surgical interventions. Given the craniofacial anomalies associated with PDS, orthodontic treatment aims to address the maxillary transverse deficit and retrognathia. Currently, there is no evidence regarding the impact of orthodontic therapy on OSA levels among PDS patients. This study reports the long-term morphological and functional changes in the upper airway of a PDS patient following adenotonsillectomy and uvulopalatoplasty at an early age (3.6 years) and orthodontic camouflage in late mixed dentition (10 years). Polysomnographies (PSGs), nuclear magnetic resonance (NMR), and lateral cephalograms taken before and after ENT surgery and orthodontic treatment were analyzed. Lateral X-rays were evaluated for changes in the posterior airway space (PAS), while polysomnographies provided the apnea–hypopnea index (AHI). The NMR scans were segmented to measure the perimeter and radius of the upper airway. The findings of this study indicate that improvements following uvulopalatoplasty (UPP) were partial and temporary. Nonetheless, orthodontic therapy and the use of elastics did not appear to influence the PAS or AHI. Future studies with larger cohorts are needed to evaluate the long-term effectiveness of the UPP procedure. This study was conducted in accordance with the CARE guidelines. [ABSTRACT FROM AUTHOR]

Abstract Background As part of China’s medical insurance-related grouping payment reform, public hospitals, which are the primary providers of medical insurance services, face remarkable pressure to control costs. This study examined uvulopalatopharyngoplasty (UPPP) surgery for patients with obstructive sleep apnea (OSA) at Hospital C to identify factors influencing inpatient costs and assess the impact of payment reform on treatment practices. Methods Using data from 251 OSA patients undergoing UPPP at Hospital C, the study evaluated changes in cost reduction, cost structure, patient disease severity, and medical quality before and after the payment reform. Results Inpatient costs for OSA patients undergoing UPPP surgery significantly decreased following the trial implementation of CHS-DRG, with notable reductions in medication and consumable expenses, as well as a shorter length of hospitalization. The CHS-DRG reform did not affect illness severity, patient safety during hospitalization, or long-term surgical outcomes for OSA patients. Conclusion After the CHS-DRG reform, Hospital C proactively adjusted clinical pathways to manage costs and improve inpatient turnover efficiency without resorting to cost-shifting, patient refusal, or staged surgeries. Despite the financial pressures, hospitals should aim to establish a win-win mechanism between hospitals, physicians, and patients, enhance internal management, and improve financial performance. Additionally, medical security authorities should explore more precise DRG payments and value-based payment models to promote high-quality hospital development rather than impose constraints. Study approval This study was approved by the Ethics Committee of Beijing Tsinghua Changgung Hospital (Approval No. 23418-0-02).

Background/Objectives: Uvulopalatopharyngoplasty (UPPP) is a prevalent surgical procedure for treating obstructive sleep apnea. Effective postoperative pain management is crucial for patient comfort and recovery. This study aimed to compare the analgesic efficacies of parecoxib and ketorolac in patients undergoing UPPP. Methods: A prospective, randomized, double-blind study was conducted on 83 patients who received either parecoxib (40 mg intravenously every 12 h) or ketorolac (30 mg intravenously every 8 h) for 2 days following UPPP. Postoperative pain and swallowing discomfort were assessed using visual analog scales (VASs) at 4, 24, 48, and 72 h. The time to resume eating and adverse reactions were also recorded. Results: At 24 and 48 h postoperatively, the mean VAS score was significantly higher in the ketorolac group compared to the parecoxib group (5.0 ± 2.3 vs. 3.6 ± 2.2, p = 0.005 and 3.9 ± 2.2 vs. 2.5 ± 1.7, p < 0.001, respectively). However, no significant difference in the mean VAS scores was observed between the two groups at 72 h postoperatively. With regards to postoperative swallowing pain, the ketorolac group exhibited significantly higher mean VAS scores than the parecoxib group at 4, 24, 48, and 72 h postoperatively. Conclusions: Intravenous parecoxib may offer superior analgesic benefits in the early postoperative period, particularly in alleviating swallowing pain, compared to ketorolac in UPPP procedures. [ABSTRACT FROM AUTHOR]

BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Introduction: Knowing an individualized outcome prediction is essential when counseling patients before surgery. We aim to identify predictors and build a model for the outcome of radiofrequency uvulopalatopharyngoplasty with tonsillectomy (rfUPPP + TE). Methods: All adult patients undergoing rfUPPP + TE for sleep-disordered breathing from 2015 to 2022 in our institution were included. Preoperative evaluations included detailed upper airway examinations and standardized questionnaires. Postoperative outcomes were measured through home sleep apnea testing and repeated questionnaires 3 months post-surgery. The primary endpoint was the postoperative apnea-hypopnea index (AHI) and the AHI responders using the Sher criteria. Results: We analyzed 247 patients with a mean age of 46 ± 11 years, predominantly male (88.7%), and a mean BMI of 29.0 kg/m2. The mean AHI was reduced from 26.4 ± 18.6/h preoperatively to 16.2 ± 14.6/h postoperatively. Daytime sleepiness improved from 8.9 ± 48 to 4.0 ± 3.1 and snoring from 7.9 ± 2.1 to 3.3 ± 2.2. Multivariate analysis indicated that higher tonsil grades, preoperative AHI, and snoring levels were associated with a greater reduction in AHI. Age and body weight were negative predictors for AHI reduction. For AHI responders, according to Sher, tonsil grade was the only predictor in a multivariate analysis. The ROC curve of this simple model, with a corrected AUC of 0.625, compared favorably against two established models. Conclusion: Our study highlights that tonsil grade, preoperative AHI, snoring, and, to a smaller extent, age and weight are key determinants of AHI reduction, emphasizing the importance of preoperative evaluation. Despite the multifactorial nature of obstructive sleep apnea, preoperative evaluation can predict the outcome of rfUPPP + TE and guide surgical planning.

Objectives: The aim of this study was to evaluate the efficacy of uvulopalatopharyngoplasty (UPPP) and the corresponding postoperative morphometrical changes. Methods: Patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Pre- and postoperative tests, including CTs, pharyngeal volume (PV), cross-sectional area (CSA), and six-category morphometrical studies, were performed. Results: Of 11 patients included, 10 showed improvement of symptoms. BMI correlated with the respiratory event index (REI). In terms of PV, there was a significantly wider postoperative area. The rate of change between preoperative REI and postoperative REI (ΔREI) correlated with the amount of change of PV between preoperative PV and postoperative PV (ΔPV). CSA increased postoperatively and correlated with REI. Uvula space (UV) and distance between the hyoid bone and the base of the tongue (HB) increased postoperatively, and posterior airway space (PAS) and epiglottic space (Epi) decreased postoperatively. UV and PAS were significant (p = 0.046, 0.014). UV was related to REI. Conclusion: Widening the PV, increasing CSA, and the posterior movement of the tongue base after UPPP surgery were found. The improvement of REI did not depend only on volume. These results suggest that it was important not only to widen the PV but also to improve the shape of the pharynx. [ABSTRACT FROM AUTHOR]

Pycnodysostosis (PDS) is an autosomal recessive form of osteosclerotic skeletal dysplasia characterized by craniofacial anomalies, a high-arched palate, and a narrowed pharyngeal space due to mandibular and maxillary deficiencies. These structural anomalies in the upper airway predispose PDS patients to obstructive sleep apnea (OSA). OSA can be managed in PDS patients using either a conservative (non-surgical and multidisciplinary) approach or surgical interventions. Given the craniofacial anomalies associated with PDS, orthodontic treatment aims to address the maxillary transverse deficit and retrognathia. Currently, there is no evidence regarding the impact of orthodontic therapy on OSA levels among PDS patients. This study reports the long-term morphological and functional changes in the upper airway of a PDS patient following adenotonsillectomy and uvulopalatoplasty at an early age (3.6 years) and orthodontic camouflage in late mixed dentition (10 years). Polysomnographies (PSGs), nuclear magnetic resonance (NMR), and lateral cephalograms taken before and after ENT surgery and orthodontic treatment were analyzed. Lateral X-rays were evaluated for changes in the posterior airway space (PAS), while polysomnographies provided the apnea–hypopnea index (AHI). The NMR scans were segmented to measure the perimeter and radius of the upper airway. The findings of this study indicate that improvements following uvulopalatoplasty (UPP) were partial and temporary. Nonetheless, orthodontic therapy and the use of elastics did not appear to influence the PAS or AHI. Future studies with larger cohorts are needed to evaluate the long-term effectiveness of the UPP procedure. This study was conducted in accordance with the CARE guidelines.

Objective: To determine the efficacy of a tongue‐retaining device (TRD) in predicting the outcomes of oropharyngeal surgery in patients with obstructive sleep apnea (OSA) before surgery. Study Design: A prospective case‐control study. Setting: A single tertiary medical center. Methods: Patients with moderate‐severe OSA who underwent both uvulopalatopharyngoplasty and tongue base suspension between January 2022 and July 2022 were included. Each patient underwent a series of 3 overnight polysomnography. Objective outcomes include apnea‐hypopnea index (AHI), minimal oxygen saturation, and reduction rate of AHI. The correlation between the reduction rate of AHI with TRD and surgery was analyzed with linear regression. Results: The reduction rates of AHI were significantly different between the group using TRD (44 ± 24%) and the postoperative group (55 ± 21%). The cross‐tabulation revealed a strong association between a positive response to TRD treatment and a positive response to surgery. The use of TRD to evaluate surgical response demonstrated a positive predictive value of 90% and a negative predictive value of 70%. A strong correlation between the decrease in AHI was observed in both TRD and surgery groups, which was demonstrated by a steep slope in the scatter plot and a significant simple linear regression line. Conclusion: Preoperative TRD response is an accurate tool for predicting the success of oropharyngeal surgery in managing OSA patients before surgical treatment. Furthermore, a quantifiable positive linear correlation exists between the efficacy of preoperative TRD treatment and surgery. [ABSTRACT FROM AUTHOR]

Aims: Obstructive sleep apnea (OSA) is characterized by episodic sleep state–dependent upper airway collapse. OSA can markedly decrease quality of life (QoL) and productivity. Continuous Positive Airway Pressure (CPAP) has been used as an effective treatment for OSA. Recently, uvulopalatopharyngoplasty (UPPP) treatment has emerged as effective management among patients with OSA, especially non-adherent ones to conventional therapies such as CPAP. Our aim was to determine whether CPAP and UPPP treatment could improve the quality of life in patients with moderate OSA. Design: Prospective. Setting: Patients with moderate OSA, confirmed by polysomnography from March 2019 to March 2020, participated. CPAP and UPPP treatments were considered for patients according to their preferences. The Sleep Apnea Quality of Life Index (SAQLI) questionnaire before and after treatment was completed. Methods: Change in their QoL was compared between the CPAP group and UPPP treatment. In addition, QoL was compared between these groups and patients who did not receive any of these treatment methods. Results: Seventy-eight patients were included in treatment groups, 40 using CPAP and 38 undergoing UPPP treatment. Furthermore, 10 patients who did not receive treatment were considered the control. Both methods of treatment significantly (p < 0.001) improved QoL, but UPPP treatment was superior (p = 0.042) to CPAP. There was a poor correlation between post-treatment BMI (0.037), Respiratory Disturbance Index (RDI) (0.096), age (0.022), and post-treatment SAQLI score. Conclusion: Based on these results, CPAP and UPPP treatment can improve QoL. UPPP treatment could be considered an effective arm of OSA management among the study population. [ABSTRACT FROM AUTHOR]

Background and Objectives In the past, palate surgery, such as uvulopalatopharyngoplasty (UPPP), was widely performed to treat obstructive sleep apnea (OSA). However, since the introduction of reimbursement for positive airway pressure (PAP) therapy in 2018, it is believed that the frequency of these operations has significantly declined. Despite this, there are currently no definitive data to support this assertion. Methods We examined the number of palate operations conducted by utilizing medical statistical data from the Health Insurance Review and Assessment Service (HIRA) Bigdata Open portal. Within this system, we queried UPPP (Q2196), UPPP_complex (Q2195), and uvulectomy (Q2197), and collected data spanning from 2010 to 2021. The data were then analyzed according to hospital type, sex, and age groups. Results In total, 2,728 palate operations were performed in 2010; this number peaked at 4,330 cases in 2014, and then steadily decreased to 3,096 cases in 2021. Of the operations in 2010, 1,892 were conducted in general hospitals, while 836 took place in primary hospitals and clinics. However, by 2021, the number of operations performed in general hospitals had decreased to 1,002, while those performed in primary hospitals and clinics had increased to 2,093. The most common age group for these operations was 30–39 for men and 40–49 for women. Since 2019, the proportion of palate operations relative to the number of OSA patients has decreased. Conclusion The frequency of palate surgery in Korea started to decrease after 2014. Despite this, there was an increase in the number of these operations performed in hospitals and clinics, with middle-aged patients being the primary recipients. The ratio of palate operations to OSA patients has shown a notable decrease after the introduction of reimbursement of polysomnography and PAP therapy.

Abstract Background To investigate the relationship between tongue fat content and severity of obstructive sleep apnea (OSA) and its effects on the efficacy of uvulopalatopharyngoplasty (UPPP) in the Chinese group. Method Fifty-two participants concluded to this study were diagnosed as OSA by performing polysomnography (PSG) then they were divided into moderate group and severe group according to apnea hypopnea index (AHI). All of them were also collected a series of data including age, BMI, height, weight, neck circumference, abdominal circumference, magnetic resonance imaging (MRI) of upper airway and the score of Epworth Sleepiness Scale (ESS) on the morning after they completed PSG. The relationship between tongue fat content and severity of OSA as well as the association between tongue fat content in pre-operation and surgical efficacy were analyzed.Participants underwent UPPP and followed up at 3rd month after surgery, and they were divided into two groups according to the surgical efficacy. Results There were 7 patients in the moderate OSA group and 45 patients in the severe OSA group. The tongue volume was significantly larger in the severe OSA group than that in the moderate OSA group. There was no difference in tongue fat volume and tongue fat rate between the two groups. There was no association among tongue fat content, AHI, obstructive apnea hypopnea index, obstructive apnea index and Epworth sleepiness scale (all P > 0.05), but tongue fat content was related to the lowest oxygen saturation (r=-0.335, P

The aim. To assess the correlation between subjective measurements and objective volume of palatine tonsils in adults, and to test the effect of oropharyngeal anatomy, body mass index, age, and OSA severity on actual tonsil volume. In addition, we evaluated the effect of tonsil size on the development of OSA in adults. Materials and methods. A prospective study of 130 patients with rhonchopathy and obstructive sleep apnea syndrome was conducted. Patients underwent a physical examination, nocturnal polysomnography, Epworth Sleepiness Scale, body mass index (BMI, kg/m²), and a subjective assessment of snoring on an analog scale from 1 (not important) to 10 (worst possible). Results: pharyngeal tissues are also found to be proportional to body size in both patients with rhonchopathy and patients with OSA, which indicates a secondary role of anatomy in the pathogenesis of OSA development. Tonsil volume (p = 0.053) tended to correlate with the degree of severity OSA There were no significant differences in the mean apnea-hypopnea index (AHI) between patients with grade I (30.5), II (29.6), or III (38.2) tonsil hypertrophy. Patients with grade IV tonsil hypertrophy had a higher AHI (mean 103.2) than patients with grade I (p = 0.01), II (p = 0.01) or III (p = 0.03) hypertrophy. Conclusions: In adult patients with rhonchopathy and OSA, there is a reliable correlation between the clinical degree of tonsil hypertrophy and the objective volume of the tonsils. Possible changes in pharyngeal geometry associated with OSA do not affect the clinical ability to determine tonsil volume. Although tonsil volume correlates with AHI, clinically only grade IV tonsils are predictive of severe OSA. Pharyngeal tissue volume likely reflects body mass index rather than OSA.

Abstract Background The majority of obstructive sleep apnea cases involve the oropharynx. The hypercollapsibility of the upper airway walls (UAWs) was the cause of obstructive sleep apnea syndrome (OSAS), which most often manifested itself at the retropalatal and/or retrolingual level. Modular and adaptable barbed snore surgery (BSS) is a novel treatment for retropalatal OSA (based on the anatomy and findings of drug-induced sleep endoscopy (DISE). Objectives To compare between the outcomes of uvulopalatopharyngoplasty and the barbed reposition palatopharyngoplasty technique, and to establish if there is indeed a significant variance in post-operative results among both types of surgeries. Patients and methods This was a prospective randomized clinical trial conducted on Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, and it was carried out on 50 patients (28 males and 22 females) suffering from OSAS. They were randomly distributed into two groups: group A and group B. Results There was a substantial distinction among the two groups regarding to post-operative data, comparison between values of all domains of Sleep Apnea Quality of Life Index (SAQLI) and bleeding and nasal regurgitation after surgery. There was no substantial distinction among the two groups in terms of age, sex, body mass index (BMI), smoking, hypertension, and diabetes mellitus. Conclusion Barbed reposition pharyngoplasty is superior to traditional uvulopalatopharyngoplasty in terms of results of Apnea Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and in Sleep Apnea Quality of Life Index (SAQLI) in addition to producing less post-operative complications as well as being easy to learn.

Purpose: This study aims to compare the efficacy of Uvulopalatopharyngoplasty + Tongue Base Radiofrequency (TB-RF) and Uvulopalatopharyngoplasty + modified thyrohyoid suspension techniques + TB-RF which aimed to suspend base of tongue muscles anteriorly toward thyroid cartilage. Methods: This randomized controlled trial study was conducted on 48 cases of confirmed OSA between Jan, 2019 and Aug, 2022. We divided patients into two groups. One group underwent Uvulopalatopharyngoplasty + modified thyrohyoid suspension + TB-RF technique, and another one underwent Uvulopalatopharyngoplasty + TB-RF. Then, Apnea–Hypopnea Index (AHI), mean and lowest O2 saturation, Drug-Induced Sleep Endoscopy (DISE), Epworth Sleepiness Scale (ESS), Digit Symbol Substitution Test (DSST), Stanford Subjective Snoring Scale (SSSS), and T90 indexes were evaluated before and after each surgery. Results: The mean ± SD age was 39.4 ± 11.17 years. Of the 48 patients, 79.1% (n = 33) were male and 20.9% (n = 15) were female. AHI and SSSS in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group were significantly better than Uvulopalatopharyngoplasty group (P-value; 0.010). Though, there was no significant difference in terms of mean saturation, lowest desaturation, ESS, DSST, and T90 scores. The success rate in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension and Uvulopalatopharyngoplasty groups, according to the Sher criteria: a minimum of 50% reduction with a final AHI less than 20, were 75% (18/24) and 41.7% (10/24), respectively. It was significantly higher in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group (P-value: 0.021). Conclusion: The addition of modified thyrohyoid suspension technique to Uvulopalatopharyngoplasty have better surgical outcomes and more success rate than Uvulopalatopharyngoplasty in OSA patients. Trial registration: IRCT: IRCT20190602043791N2. https://en.irct.ir/trial/53365. [ABSTRACT FROM AUTHOR]

Background: To investigate the relationship between tongue fat content and severity of obstructive sleep apnea (OSA) and its effects on the efficacy of uvulopalatopharyngoplasty (UPPP) in the Chinese group. Method: Fifty-two participants concluded to this study were diagnosed as OSA by performing polysomnography (PSG) then they were divided into moderate group and severe group according to apnea hypopnea index (AHI). All of them were also collected a series of data including age, BMI, height, weight, neck circumference, abdominal circumference, magnetic resonance imaging (MRI) of upper airway and the score of Epworth Sleepiness Scale (ESS) on the morning after they completed PSG. The relationship between tongue fat content and severity of OSA as well as the association between tongue fat content in pre-operation and surgical efficacy were analyzed.Participants underwent UPPP and followed up at 3rd month after surgery, and they were divided into two groups according to the surgical efficacy. Results: There were 7 patients in the moderate OSA group and 45 patients in the severe OSA group. The tongue volume was significantly larger in the severe OSA group than that in the moderate OSA group. There was no difference in tongue fat volume and tongue fat rate between the two groups. There was no association among tongue fat content, AHI, obstructive apnea hypopnea index, obstructive apnea index and Epworth sleepiness scale (all P > 0.05), but tongue fat content was related to the lowest oxygen saturation (r=-0.335, P < 0.05). There was no significantly difference in pre-operative tongue fat content in two different surgical efficacy groups. Conclusions: This study didn't show an association between tongue fat content and the severity of OSA in the Chinese group, but it suggested a negative correlation between tongue fat content and the lowest oxygen saturation (LSaO2). Tongue fat content didn't influence surgical efficacy of UPPP in Chinese OSA patients. Trial registration: This study didn't report on a clinical trial, it was retrospectively registered. [ABSTRACT FROM AUTHOR]

Background and Objectives Although positive airway pressure (PAP) is known to be more effective than uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea (OSA), PAP is a more expensive treatment in Korea. Therefore, it is necessary to compare the cost-effectiveness of these two treatments. Methods We assumed patients with moderate to severe OSA and divided them into three groups: those who used PAP (the PAP Treatment group), those who received UPPP (surgery group), and those who did not receive a diagnosis or treatment (No Treatment group). We compared their medical costs over 10 years. The incidence rate of common complications and accidents (coronary heart disease, heart failure, stroke, depression, diabetes, vehicle accident, and work-related accident) with or without treatment was adopted through a literature review. The average medical expenses for treating each complication and accident were also found by searching several databases. Results The incidence of all complications was higher in the control group than in the PAP Treatment group or the surgery group. However, since the absolute incidence rate was not high in all groups and medical expenses in Korea are low, the expected treatment cost was not high (KRW 108,209 per year for the PAP Treatment group, KRW 141,228 for the surgery group, and KRW 178,369 for the No Treatment group). In contrast, the costs of a polysomnography examination, PAP rental, and mask purchase were relatively high. Based on these results, the 10-year medical expenses for the PAP Treatment group were KRW 10,246,948, and those for the surgery were only KRW 925,095. Conclusion Although PAP treatment reduces the incidence of complications in OSA patients, it is not as cost-effective as UPPP in Korea, where medical costs are low.

This retrospective study compared the effectiveness of different materials used in Uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea treatment, focusing on the impact on bleeding control, pain control, and healing ability. The study population comprised 213 patients who underwent UPPP at Wan-Fang Hospital between July 2018 and October 2022 divided into four groups based on the postoperative material used: No Material Use Group, Tissue Glue Group, Platelet-Rich Plasma (PRP) Group, and Polyglycolic Acid (PGA) Sheet Group. Results showed significant differences in operation time and intraoperative bleeding amount among the groups, with the Tissue Glue Group demonstrating the shortest operation time. While no significant differences in postoperative pain at 24 h were observed, PRP and PGA Sheet groups exhibited lower average pain scores in cases with higher pain levels. Postoperative complications and emergency room visits due to pain or bleeding varied among the groups, with the No Material Use Group having the highest incidence, although no statistical significance was achieved. This study provides insights into the potential benefits of using advanced materials in UPPP, guiding future research and clinical practice to improve patient care and outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Predictors for the outcome of uvulopalatopharyngoplasty with and without tonsillectomy (UPPP ± TE) in sleep-disordered breathing have not been fully established. This study investigates tonsil grade, volume, and preoperative examination in predicting radiofrequency UPP ± TE outcomes. Methods: All patients undergoing radiofrequency UPP with tonsillectomy if tonsils were present between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical examination, including Brodsky palatine tonsil grade from 0 to 4. Preoperatively and 3 months after surgery, sleep apnea testing was performed using respiratory polygraphy. Questionnaires were administered assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) and snoring intensity on a visual analog scale. Tonsil volume was measured intraoperatively using water displacement. Results: The baseline characteristics of 307 patients and the follow-up data of 228 patients were analyzed. Tonsil volume increased by 2.5 ml (95% CI 2.1–2.9 ml; P < 0.001) per tonsil grade. Higher tonsil volumes were measured in men, younger patients, and patients with higher body mass indices. The preoperative apnea–hypopnea index (AHI) and AHI reduction strongly correlated with tonsil volume and grade, whereas postoperative AHI did not. The responder rate increased from 14% to 83% from tonsil grade 0 to 4 (P < 0.01). ESS and snoring were significantly reduced after surgery (P < 0.01), but the reduction was not influenced by tonsil grade or volume. No other preoperative factor other than tonsil size could predict surgical outcomes. Conclusions: Tonsil grade and intraoperatively measured volume correlate well and predict the reduction of AHI, while they are not predictive of ESS and snoring response after radiofrequency UPP ± TE. [ABSTRACT FROM AUTHOR]

Background: In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess soft tissue to less invasive reconstruction techniques that aim to preserve pharyngeal function while effectively managing sleep apnea. This review aims to evaluate and compare the efficacy of the surgical techniques utilized for OSA at the level of the palate and pharynx. It will cover both traditional and novel procedures. Methods: A comprehensive search of the major databases, such as PubMed/MEDLINE, Web of Science, and Scopus, was conducted to identify the relevant literature. We included articles written in English that analyzed the outcomes of adult patients who received velopharyngeal surgery for sleep apnea. Only comparative studies that examined at least two techniques were considered. Results: In all of the studies combined, the total number of patients who underwent velopharyngeal surgery was 614 in eight studies. All surgical procedures resulted in improvements in the apnea–hypopnea index (AHI). The highest success rates and best outcomes were achieved by barbed reposition pharyngoplasty (BRP) in most studies, ranging from 64.29% to 86.6%. BRP also demonstrated the most significant improvements in both objective and subjective parameters closely followed by ESP that obtained similar efficiency in some studies, especially when combined with anterior palatoplasty (AP), but with a higher incidence of complications. While LP showed moderate efficiency compared with BRP or ESP, the UPPP techniques exhibited greater outcome variability among studies, with a success rate ranging from 38.71% to 59.26%, and the best results observed in a multilevel context. Conclusions: In our review, BRP was the most preferred, effective, and safe among all velopharyngeal techniques, closely followed by ESP. However, older described techniques also showed good results in well-selected patients. Larger-scale studies, preferably prospective, that rigorously incorporate DISE-based strict inclusion criteria might be needed to assess the efficacy of different techniques and generalize the findings. [ABSTRACT FROM AUTHOR]

Purpose: Uvulopalatopharyngoplasty (UPPP) can aggravate lung inflammatory reactions in patients with obstructive sleep apnoea syndrome (OSAS). Dexmedetomidine (Dex) is a selective α-2 adrenoreceptor agonist that can alleviate lung injury. This study was designed to investigate the effects of Dex on oxygenation and inflammatory factors in patients undergoing UPPP in the early perioperative period. Methods: Patients with OSAS undergoing UPPP were randomly allocated to the Dex Group or Control Group. Arterial blood gas analyses were performed, and the respiratory index (RI) and oxygenation index (OI) were calculated upon entering the operating room (T0) and immediately after surgery (T3). The inflammatory factors tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured at T0 and T3. Results: A total of 44 patients with OSAS were randomized. There was no significant difference in basic patient characteristics between the two groups. The preoperative RI and OI were not significantly different between the two groups, but they were altered immediately after surgery relative to the corresponding preoperative value (p < 0.05). Compared with the Control Group, the RI was significantly lower at T3 in the Dex Group (p < 0.001). However, there was no significant difference in the OI between the two groups (p = 0.128). The inflammatory factors TNF-α (p < 0.001) and IL-6 (p = 0.018) were lower, while IL-10 was higher in the Dex Group than in the Control Group (p < 0.001). Conclusion: Dexmedetomidine can improve the oxygenation and inhibit the inflammatory response in patients undergoing UPPP in the early perioperative period. Trial registration: The present clinical study has been registered at Clinical Trials under number NCT03612440. [ABSTRACT FROM AUTHOR]

This retrospective evaluation of surgical outcomes for hyomandibular suspension when performed with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA). Thirty-nine patients with moderate-to-severe OSA were treated with hyoid myotomy and suspension and uvulopalatopharyngoplasty. Patients underwent hyoid advancement and suspension to the mandible (Encore System) with either staged or concurrent UPPP. The primary outcome was a successful surgical result, defined as an apnea hypopnea index (AHI) lower than 20, and a 50% or greater decline in AHI on postoperative polysomnography. Successful surgical results were achieved in 30 (76.9%) out of 39 patients. The mean preoperative AHI improved 69.2% from 49.9 ± 25.6 to 15.4 ± 14.9 (P <.001) postoperatively. All patients reported clinical improvement of symptoms. There were 4 wound complications and one infection requiring removal of hardware. For patients with multilevel obstructive sleep apnea, hyoid advancement and suspension to the mandible appears efficacious when performed in conjunction with uvulopalatopharyngoplasty. [ABSTRACT FROM AUTHOR]

Background: Surgery for obstructive sleep apnea (OSA) has changed in concept and technique that transformed from radical excision to functional reconstruction. The aim of this study was to investigate the safety and effectiveness of palatal hybrid surgery in OSA patients. Methods: Palatal hybrid surgery is a tissue-specific technique (mucosa-preservation, tonsil-excision, fat-ablation, muscle-relocation/suspension) used in treating OSA patients with velopharyngeal obstruction. The study included 46 consecutive adults OSA patients. The palatal hybrid surgery annotates uvulopalatopharyngoplasty in stereoscopic reconstruction of tonsillar fossa (pharyngoplasty), omni-suspension of the soft palate (palatoplasty) and advancement of uvula (uvuloplasty). Results: No patient experienced airway compromise, voice change or persistent nasal regurgitation following palatal hybrid surgery. One patient existed postoperative tonsillar fossa bleeding received conservative treatment. Postoperative pain in visual analogue scale (VAS) showed average score of 3, 3, 2, 0 at the 1st, 3rd, 7th, 14th day, respectively. Perioperative snoring severity (VAS) (8.7 vs 2.6) and daytime sleepiness (Epworth Sleepiness Scale) (11.3 vs 5.5) all improved significantly (p

It is uncertain which factors substantially influence outcomes after uvulopalatopharyngoplasty (UPPP) in patients with supine predominant obstructive sleep apnea (POSA) To explore the predictors of UPPP outcomes in POSA patients. A total of 108 patient(52 positional patients (POSA) and 56 nonpositional patients(NPP)), who underwent the revised uvulopalatopharyngoplasty (H-UPPP), were retrospectively studied. The pre-operative information of these patients, including polysomnography (PSG), and upper airway CT, were collected for analysis. No difference was found in surgical success rates between POSA and NPP undergoing H-UPPP. In POSA patients, there were statistically significant differences between responders and nonresponders in body mass index (BMI), preoperative supine AHI, time of SaO2 < 90% (TS90) (all p <.05), minimal anteroposterior airway (mAP) (p =.016), minimal lateral airway (mLAT) (p =.002), minimal cross-sectional airway area (mCSA) (p <.001) at the velopharynx. mLAT (p =.014) and mCSA (p =.002) at the glossopharynx. The independent associated factors for surgical success were lower BMI (p <.001), narrowerm LAT (p =.002) and mAP (p <.001) at velopharynx, and wider mCSA (p <.001) at glossopharynx in POSA. POSA patients with lower BMI, narrower mLAT and mAP at velopharynx, wider mCSA at glossopharynx were more likely to achieve a positive outcome with H-UPPP. [ABSTRACT FROM AUTHOR]

Background: The opioid receptors related to analgesia are mainly μ recipient, the μ receptor has a two-way mode of action: manifested by opioid analgesics and μ1 Receptor binding produces the desired analgesic effect, and μ2 Receptor binding may cause respiratory depression, nausea and vomiting and other adverse reactions. Nalmefene is an opioid receptor antagonist. Low dose Nalmefene has priority over μ2 Receptor binding makes opioid analgesics turn more to μ1 receptor binding, which is reversed μ2 Receptor mediated nausea, vomiting, respiratory depression and other adverse reactions, but does not reverse the analgesic effect. We assume that sufentanil combined with nalmefene could reduce respiratory adverse events in the patients who underwent uvulopalatopharyngoplasty during recovery.Methods: Patients with UPPP under general anesthesia were selected, and divided into control group (group C) and nalmefene group (group N) randomly. Patients in group N received sufentanil 0.1 μg/kg and nalmefene hydrochloride 0.25μg/kg at the end of the operation. Additionally, patients in group C received sufentanil 0.1 μg/kg at the end of the operation. The heart rate (HR) and mean arterial pressure (MAP) were observed and recorded before operation, immediately after extubation, and 5 min after extubation. The breathing recovery time, tracheal extubation time, consciousness score (Ramsay score、sedation-agitation scale (SAS)) and visual analog score (VAS) were carefully recorded at 5 min after extubation, and the various adverse reactions were monitored during the recovery period.Results: Ninety-six patients were finished our study finally. The breathing recovery and extubation time of group N was significantly shorter than those of group C (P

The aim of this study is to evaluate the efficacy of uvulopalatopharyngoplasty and the corresponding postoperative airflow. Eleven patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Computational fluid dynamics (CFD) was implemented. CFD could be accomplished in nine cases. Airflow analysis was not possible in cases with a high respiratory event index (REI) score. Before surgery, stenosis was identified in the oropharynx and epiglottic area. And the airflow velocity and pressure were found to have significantly decreased in the oropharynx postoperatively, while in the epiglottic area, those data had increased postoperatively in some cases. The velocity and pressure of the oropharynx are related to REI score. From the CFD analysis, airflow analysis is important for evaluating the apnea state. It is suggested that the postoperative function can now be predicted preoperatively. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and success rates of lateral pharyngoplasty techniques (LP) vs. uvulopalatopharyngoplasty (UPPP) among adult patients surgically treated for obstructive sleep apnea. Methods: A systematic literature review of the last 20 years' papers was conducted using PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library until April 2021. Only full-text English articles comparing LP and UPPP outcomes in adult patients with objective outcomes were included in the study. Results: We included 9 articles for a total of 312 surgically treated patients with OSA. LP techniques for obstructive sleep apnea were used on 186 (60%) subjects, while 126 patients (40%) were treated with UPPP. Both surgical procedures resulted in significant improvements in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and lowest oxygen saturation (LOS) (p < 0.001 in all cases). Although better outcomes were reported with lateral pharyngoplasty, the differences were not significant compared to UPPP post-operative results (p > 0.05 in all cases). Conclusions: UPPP and LP are both effective surgical procedures in treating OSA in adults. Although not significant, LPs demonstrated improved post-operative outcomes. However, further evidence comparing the surgical effect on patients with OSA is needed to discriminate post-operative outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether sleep surgery is associated with inflammatory cytokine changes. This study hypothesizes cytokines may change after surgery in adult obstructive sleep apnea (OSA). Study Design: Systematic review and meta‐analysis. Methods: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched PubMed, Embase, and Cochrane review databases from their inception to June 2021. The keywords used were sleep apnea, inflammatory markers, cytokines, and surgery. The effects of sleep surgery on the apnea–hypopnea index (AHI) and inflammatory cytokines were evaluated using a random‐effects model. Both mean difference (MD) and standardized mean difference (SMD) of the changes in cytokines were calculated. Results: Nine studies with 235 adults were included (mean age: 43 years; 82% were men). After sleep surgery, AHI significantly reduced by −11.3 events/h (95% confidence interval [CI], −15.8 to −6.9). In total, 8 and 6 studies were pooled for examining tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) levels, respectively. Sleep surgery significantly reduced TNF‐α levels, with an MD of −2.8 pg/ml (95% CI, −5.1 to −0.6) and an SMD of −0.56 (95% CI, −0.85 to −0.27). Furthermore, sleep surgery reduced IL‐6 levels, with an MD of −0.6 pg/ml (95% CI, −1.0 to −0.2) and an SMD of −0.66 (95% CI, −0.89 to −0.43). No covariates were identified to be correlated with cytokine changes in subgroup and meta‐regression analyses. Funnel plots showed possible publication bias in current data. Conclusions: In adults, OSA treatment with sleep surgery improves inflammatory cytokines. Laryngoscope, 132:2275–2284, 2022 [ABSTRACT FROM AUTHOR]

BackgroundObstructive sleep apnea hypopnea syndrome (OSAHS) may cause Alzheimer’s disease (AD), t-tau, p-tau, Aβ42, and Aβ40 are important elements in the process of AD, and changes in the levels of these biomarkers may affect the cognitive functioning of patients. Our objective was to investigate whether uvulopalatopharyngoplasty could reduce the plasma levels of AD biomarkers in OSAHS patients and the potential correlations of AD biomarkers with cognitive impairment and sleepiness, and explore the independent influencing factors of cognitive function.MethodsAlzheimer’s disease biomarkers were measured in the plasma of 35 patients with severe OSAHS requiring surgical treatment and 16 healthy controls without OSAHS. The cognitive function and sleepiness of OSAHS patients was also evaluated. The case group was given uvulopalatopharyngoplasty and followed at the postoperative sixth month, the follow-up cases were 27, and plasma AD biomarker levels, cognitive function, and sleepiness were re-evaluated. The preoperative and postoperative AD biomarker levels OSAHS patients were compared with each other and those of the control group. Linear stepwise regression and lasso regression were used to explore the relationships of AD biomarkers with cognitive impairment and sleepiness.ResultsSignificantly higher Aβ40, t-tau, p-tau in plasma were observed preoperatively in OSAHS patients comparing to controls (29.24 ± 32.52 vs. 13.18 ± 10.78, p = 0.049; 11.88 ± 7.05 vs. 7.64 ± 4.17, p = 0.037; 26.31 ± 14.41 vs. 17.34 ± 9.12, p = 0.027). The sixth month of postoperation, the plasma AD biomarkers (Aβ42, Aβ40, t-tau, p-tau) in plasma levels decreased significantly (0.23 ± 0.17 vs. 0.20 ± 0.16, p = 0.0001; 29.24 ± 32.52 vs. 23.52 ± 24.46, p = 0.0046; 11.88 ± 7.05 vs. 8.88 ± 6.21, p = 0.0001;26.31 ± 14.41 vs. 20.43 ± 10.50, p = 0.0001). A comparison of MMSE and ESS scores from before to after surgery revealed obvious differences (27.14 ± 1.65 vs. 29.07 ± 1.78, p = 0.0001; 11.91 ± 4.84 vs. 5.89 ± 2.83, p = 0.0001). Changes in cognitive function and sleepiness scores from before to after uvulopalatopharyngoplasty were significantly correlated with AD biomarkers. Body mass index and t-tau were potential influencing factors cognitive function.ConclusionObstructive sleep apnea hypopnea syndrome can increase plasma AD biomarkers levels. Uvulopalatopharyngoplasty can improve patients’ cognition and sleepiness, and the mechanism may be related to changes in plasma AD biomarkers. Higher AHI and higher t-tau level were identified as independent risk factors for cognitive decline.

Purpose: The main purpose of this pilot study was to detect the positive effects of our self-made gargle containing honeysuckle and semen oroxyli on postoperative pain and complications after Uvulopalatopharyngoplasty (UPPP). Methods: Patients with obstructive sleep apnea (OSA) who had underwent elective UPPP during the period of April 2019 to January 2022 were randomly divided into treatment group and control group. The patients in the treatment group were instructed to gargle the solution containing honeysuckle and semen oroxyli (25 ml) four times a day for 2 weeks. The patients in the control group were instructed to gargle normal saline (25 ml) at the same schedule. The post-operative resting throat pain, swallowing throat pain and patient comfort level were evaluated at 12 h, 1 week and 2 weeks after UPPP. The post-operative complications were collected and analyzed. Results: During the study period, 218 patients completed all the post-operative assessments. For resting throat pain, the treatment group had much lower VAS scores at 1 week and 2 weeks after UPPP. For swallowing throat pain, treatment group had much lower VAS scores than control group at 2 weeks after surgery. And patients in the treatment group felt more comfortable comparing to those in control group at 1 week and 2 weeks after UPPP. Although the treatment group had less numbers of patients with post-operative wound infection or bleeding, the difference between the 2 groups was not statistically significant. Conclusion: The gargle containing honeysuckle and semen oroxyli could relieve both resting and swallowing throat pain and increase patient comfort after UPPP. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent problem of public health, which is characterized by intermittent and repetitive narrowing of the airway while sleeping. Approximately half of the patients with OSAS therapy fail to comply with continuous positive airway pressure (CPAP) because of mask-related problems, treatment-related side effects, patient attitude, or perceived lack of benefit. The aim of the surgical therapies for the treatment of OSAS is to improve airway patency by operating on selected sites of obstruction. Different surgical modalities have been developed, since different anatomical locations may be responsible for a narrow upper airway. Consequently, the surgical approach needs to be individualized for each patient. Surgical treatment of OSAS presents variable efficacy but is capable of improving mortality and morbidity rates in selected patients. However, the surgery for OSAS is not a substitute for CPAP but is a salvage treatment option for patients who have failed CPAP and other conservative treatments, or had significant side effects of device use, or have a favorable anatomy such as tonsillar hypertrophy. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnoea is a common problem with many long-term consequences if left untreated. The purpose of this study is to find the efficacy of modified uvulopalatopharyngoplasty with tonsillectomy in the treatment of OSA symptoms, apnoea-hypopnoea index, Epworth sleepiness scale and its effect on blood pressure and cardiac status. Patients with obstructive sleep apnoea with apnoea-hypopnoea index more than 15 with tonsillar hypertrophy, Friedman stage < 3 and palatal collapse or obstruction at the level of velum as diagnosed by DISE were included in this prospective analytical cross-sectional study. Modified uvulopalatopharyngoplasty with tonsillectomy was done in all patients. History of nocturnal and daytime OSA symptoms, Epworth sleepiness scale, snoring score, polysomnogram, drug induced sleep endoscopy, blood pressure, echocardiogram to measure velocity across pulmonary and aortic valve and ECG were taken preoperatively and 6 months postoperatively. A total of 129 participants were recruited. 82 of the 129 patients (63.5%) were men; mean (SD) age was 44.2 (6.78) years. The patients were post operatively classified as responders and non-responders by the DISE finding. 107 patients (82.9%)—responders, had no narrowing and 22 patients (17.1%)—non-responders, had persistent narrowing of velum. Non-responders had increased baseline BMI when compared to responders. All the parameters were statistically improved in responders (p < 0.001). In non-responders, there was no statistical improvement in any of the parameters. Modified uvulopalatopharyngoplasty provides significant improvement in sleep parameters like AHI, Epworth sleepiness scale and other polysomnographic parameters. It significantly reduces the cardiac burden in OSA patients without any complications. Trial registrationwww.ctri.nic.in identifier: CTRI/2020/06/025759 [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of a novel technique for transoral tongue suspension (TOTS) in obstructive sleep apnea (OSA) patients. Material and Methods: The retrospective study enrolled 24 consecutive OSA patients (21 males; average age, 43 years; average apnea–hypopnea index (AHI), 42.2 event/h; average body mass index (BMI), 25.7 kg/m2) with tongue obstruction confirmed by drug-induced sleep endoscopy. All patients received TOTS as the main procedure in conjunction with uvulopalatopharyngoplasty (UPPP). Key procedures of TOTS included a transoral sublabial approach, drilling two holes on the mandible, passing the polypropylene through the hole to the tongue base using a suture passer and returning the polypropylene through loop traction, and tying the polypropylene to the mandible. Lingual tonsil ablation (n = 8) was also implemented in hypertrophic lingual tonsils (grades III and IV). Results: The operation time for TOTS was around 30 min. No wound bleeding or airway compromise occurred throughout the postoperative period. Minor complications were temporary and included swelling of the tongue, numbness of the lower incisor, and sublabial wound dehiscence (n = 2). The quality of life improved significantly in the patients' subjective daytime sleepiness according to the Epworth Sleepiness Scale (11.4 ± 3.2 vs. 5.7 ± 1.6, p < 0.001). The objective parameters of OSA also improved significantly in the apnea/hypopnea index (42.2 ± 21.8 vs. 19.5 ± 16.2, p < 0.001), minimal oxygen saturation (77.1 ± 12.2 vs. 81.7 ± 8.1, p = 0.026), and snoring index (207 ± 141 vs. 101 ± 91, p = 0.03). Conclusions: The demonstrated TOTS showed its advantage in low morbidity with a scarless exterior and easy performance with free availability in treating adult OSA patients with tongue obstruction. TOTS combined with UPPP significantly improved AHI and daytime sleepiness. TOTS can be implemented with lingual tonsillectomy to achieve both stabilization of the tongue and widening of hypopharyngeal airway. [ABSTRACT FROM AUTHOR]

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The main aim of this study is to compare the incidence rate and severity of deep neck infection (DNI) in patients post-UPPP+ T (uvulopalatopharyngoplasty plus tonsillectomy) and without UPPP+ T. We utilized the data derived from the Longitudinal Health Insurance Database (LHID) of the National Health Insurance Research Database (NHIRD) in Taiwan from 1 January 2000 to 31 December 2012. Patients who had undergone combined UPPP and tonsillectomy were selected using National Health Insurance (NHI) surgical order. Patients with DNI were selected using International Classification of Diseases (ICD-9-CM) code. A logistic regression model was applied for risk analysis. There were 1574 patients in the UPPP+ T cohort, and 6,296 patients who did not undergo combined UPPP and tonsillectomy for the control group. Our analysis showed that patients with an obstructive sleep apnea syndrome (OSAS) history constitute 76.1% (n = 1198) of the UPPP+ T cohort. Compared to the control group, there was no significantly increased incidence rate of DNI after UPPP+ T within 1–60 months. Patients undergoing combined UPPP and tonsillectomy had a lower intubation rate for DNI, with an adjusted odds ratio of 0.47 (95% CI = 0.32–0.69). The combined UPPP and tonsillectomy does not increase the risk of DNI within 1–60 months. Furthermore, combined UPPP and tonsillectomy can reduce the severity for DNI by decreasing the intubation rate and length of hospitalization. [ABSTRACT FROM AUTHOR]

Purpose: The effects of sleep surgery on the lipid profile of adults diagnosed as having obstructive sleep apnea (OSA) remain unclear. This meta-analysis aimed to clarify whether sleep surgeries improve patients' lipid profile. Methods: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to September 2020 using keywords such as sleep apnea, OSA, sleep apnea syndromes, lipids, and surgery. The effects of sleep surgery on the apnea–hypopnea index (AHI) and lipid profile parameters were evaluated using a random-effects model. Results: Thirteen studies were included, with a total of 710 patients (mean age: 42.0 years; 85% men; mean sample size: 54.6 patients). The summary estimate of AHI change was − 20.6 events/h (95% CI − 25.9 to − 15.3) and the Epworth Sleepiness Scale score was − 4.2 (95% CI − 5.9 to − 2.5). Sleep surgery lowered total cholesterol (mean − 7.7 mg/dL; 95% CI − 12.2 to − 3.2), low-density lipoprotein (mean − 7.2 mg/dL; 95% CI − 11.0 to − 3.3), and triglyceride (mean − 14.0 mg/dL; 95% CI − 22.2 to − 5.8) levels but did not affect high-density lipoprotein (mean 1.5 mg/dL; 95% CI − 0.6 to 3.7) levels. Subgroup analysis revealed that the lipid profile changes were not associated with the surgical procedure but with the degree of OSA improvement. Meta-regression analyses demonstrated that the improvement in the lipid profile was positively correlated with AHI reduction. Conclusion: Surgeries for OSA may improve the lipid profile, which is positively correlated with the degree of OSA improvement. [ABSTRACT FROM AUTHOR]

This retrospective study compared the effectiveness of different materials used in Uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea treatment, focusing on the impact on bleeding control, pain control, and healing ability. The study population comprised 213 patients who underwent UPPP at Wan-Fang Hospital between July 2018 and October 2022 divided into four groups based on the postoperative material used: No Material Use Group, Tissue Glue Group, Platelet-Rich Plasma (PRP) Group, and Polyglycolic Acid (PGA) Sheet Group. Results showed significant differences in operation time and intraoperative bleeding amount among the groups, with the Tissue Glue Group demonstrating the shortest operation time. While no significant differences in postoperative pain at 24 h were observed, PRP and PGA Sheet groups exhibited lower average pain scores in cases with higher pain levels. Postoperative complications and emergency room visits due to pain or bleeding varied among the groups, with the No Material Use Group having the highest incidence, although no statistical significance was achieved. This study provides insights into the potential benefits of using advanced materials in UPPP, guiding future research and clinical practice to improve patient care and outcomes.

Background: In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess soft tissue to less invasive reconstruction techniques that aim to preserve pharyngeal function while effectively managing sleep apnea. This review aims to evaluate and compare the efficacy of the surgical techniques utilized for OSA at the level of the palate and pharynx. It will cover both traditional and novel procedures. Methods: A comprehensive search of the major databases, such as PubMed/MEDLINE, Web of Science, and Scopus, was conducted to identify the relevant literature. We included articles written in English that analyzed the outcomes of adult patients who received velopharyngeal surgery for sleep apnea. Only comparative studies that examined at least two techniques were considered. Results: In all of the studies combined, the total number of patients who underwent velopharyngeal surgery was 614 in eight studies. All surgical procedures resulted in improvements in the apnea–hypopnea index (AHI). The highest success rates and best outcomes were achieved by barbed reposition pharyngoplasty (BRP) in most studies, ranging from 64.29% to 86.6%. BRP also demonstrated the most significant improvements in both objective and subjective parameters closely followed by ESP that obtained similar efficiency in some studies, especially when combined with anterior palatoplasty (AP), but with a higher incidence of complications. While LP showed moderate efficiency compared with BRP or ESP, the UPPP techniques exhibited greater outcome variability among studies, with a success rate ranging from 38.71% to 59.26%, and the best results observed in a multilevel context. Conclusions: In our review, BRP was the most preferred, effective, and safe among all velopharyngeal techniques, closely followed by ESP. However, older described techniques also showed good results in well-selected patients. Larger-scale studies, preferably prospective, that rigorously incorporate DISE-based strict inclusion criteria might be needed to assess the efficacy of different techniques and generalize the findings.

Objective: Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design: Retrospective cohort (national database). Setting: Tertiary referral center. Methods: This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results: A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery (P <.001, P <.001, and P =.006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission (P <.001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions: Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively. [ABSTRACT FROM AUTHOR]

This article described a patient with obstructive sleep apnea syndrome, who had uvulopalatopharyngoplasty due to poor response under Continuous Positive Airway Pressure treatment. The patient was admitted on October 24, 2019, and was discharged on November 6, 2019. Upon admission, through primary care, interview, observation, and physical examination, in addition to Gordon's 11 Functional Health Patterns, the author confirmed that the patient had several health issues, such acute pain, sleep disturbances, and anxiety. With our personalized planning and utmost care, as well as the company of friends and family, the patient did not only overcome the physical discomfort but also psychological problems. In addition, patient education videos are available at any time by scanning the QR code with personal smartphone. We are hoping that nursing experiences in this case will provide references for others who will take care of similar cases. [ABSTRACT FROM AUTHOR]

PurposeTo determine whether treatment with uvulopalatopharyngoplasty (UPPP) or continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) prevents hypertension, compared to those not receiving any treatment.MethodsA retrospective cohort study was conducted among 413 patients with OSA (age ≥ 35 years) at the Shuang Ho Hospital between 2009 and 2016. The patients were divided into three groups: UPPP, CPAP, and non-treatment groups. Data about the personal characteristics, history of comorbidities, and polysomnography (PSG) reports were collected at baseline. A Cox model with inverse probability of treatment weighting was used to adjust for confounders and baseline diversity.ResultsAfter multivariate adjustment and weighting for incident hypertension, patients in both the CPAP and UPPP groups showed a significant preventive effect on hypertension than in the non-treatment group. Moreover, patients in the CPAP group had lower event rates than those in the UPPP group.ConclusionUPPP can prevent the development of new-onset hypertension in patients with OSA. CPAP had a better preventive effect than UPPP. UPPP might be a good alternative for reducing the risk of the onset of hypertension when compliance to CPAP is poor.

Objective/background: The aim of this study was to compare the efficacy of orthognathic surgery combined with soft tissue surgery with that of soft tissue surgery alone as curative treatments for moderate to severe obstructive sleep apnea (OSA) syndrome., Patients/methods: This retrospective cohort study included 50 patients aged ≥18 years who underwent orthognathic surgery combined with soft tissue surgery or soft tissue surgery alone for OSA syndrome (apnea-hypopnea index [AHI]: >15). The primary outcome was the improvement in AHI measured by overnight in-laboratory polysomnography before and at 6 months after the surgical treatment by. The secondary outcome was the postoperative AHI., Results: Twenty-eight (56 %) patients underwent orthognathic surgery combined with soft tissue surgery, while 22 (44 %) underwent soft tissue surgery only. There were no significant between-group differences in sex (p = 0.53), age (p = 0.08), body mass index (p = 0.42), and preoperative AHI (p = 0.17). The mean improvement in AHI at 6 months after surgery was significantly greater in the orthognathic surgery group than in the soft tissue surgery group (32.18 vs. 10.41; p < 0.0001). Similarly, the mean postoperative AHI was significantly lower in the orthognathic surgery group than in the soft tissue surgery group (8.46 vs. 29.62; p < 0.0001)., Conclusion: Compared with soft tissue surgery alone, orthognathic surgery combined with soft tissue surgery is more effective as curative treatment for OSA syndrome., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The main aim of this study is to compare the incidence rate and severity of deep neck infection (DNI) in patients post-UPPP+ T (uvulopalatopharyngoplasty plus tonsillectomy) and without UPPP+ T. We utilized the data derived from the Longitudinal Health Insurance Database (LHID) of the National Health Insurance Research Database (NHIRD) in Taiwan from 1 January 2000 to 31 December 2012. Patients who had undergone combined UPPP and tonsillectomy were selected using National Health Insurance (NHI) surgical order. Patients with DNI were selected using International Classification of Diseases (ICD-9-CM) code. A logistic regression model was applied for risk analysis. There were 1574 patients in the UPPP+ T cohort, and 6,296 patients who did not undergo combined UPPP and tonsillectomy for the control group. Our analysis showed that patients with an obstructive sleep apnea syndrome (OSAS) history constitute 76.1% (n = 1198) of the UPPP+ T cohort. Compared to the control group, there was no significantly increased incidence rate of DNI after UPPP+ T within 1–60 months. Patients undergoing combined UPPP and tonsillectomy had a lower intubation rate for DNI, with an adjusted odds ratio of 0.47 (95% CI = 0.32–0.69). The combined UPPP and tonsillectomy does not increase the risk of DNI within 1–60 months. Furthermore, combined UPPP and tonsillectomy can reduce the severity for DNI by decreasing the intubation rate and length of hospitalization.

Introduction: Knowing an individualized outcome prediction is essential when counseling patients before surgery. We aim to identify predictors and build a model for the outcome of radiofrequency uvulopalatopharyngoplasty with tonsillectomy (rfUPPP + TE)., Methods: All adult patients undergoing rfUPPP + TE for sleep-disordered breathing from 2015 to 2022 in our institution were included. Preoperative evaluations included detailed upper airway examinations and standardized questionnaires. Postoperative outcomes were measured through home sleep apnea testing and repeated questionnaires 3 months post-surgery. The primary endpoint was the postoperative apnea-hypopnea index (AHI) and the AHI responders using the Sher criteria., Results: We analyzed 247 patients with a mean age of 46 ± 11 years, predominantly male (88.7%), and a mean BMI of 29.0 kg/m 2 . The mean AHI was reduced from 26.4 ± 18.6/h preoperatively to 16.2 ± 14.6/h postoperatively. Daytime sleepiness improved from 8.9 ± 48 to 4.0 ± 3.1 and snoring from 7.9 ± 2.1 to 3.3 ± 2.2. Multivariate analysis indicated that higher tonsil grades, preoperative AHI, and snoring levels were associated with a greater reduction in AHI. Age and body weight were negative predictors for AHI reduction. For AHI responders, according to Sher, tonsil grade was the only predictor in a multivariate analysis. The ROC curve of this simple model, with a corrected AUC of 0.625, compared favorably against two established models., Conclusion: Our study highlights that tonsil grade, preoperative AHI, snoring, and, to a smaller extent, age and weight are key determinants of AHI reduction, emphasizing the importance of preoperative evaluation. Despite the multifactorial nature of obstructive sleep apnea, preoperative evaluation can predict the outcome of rfUPPP + TE and guide surgical planning., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Study Objectives: This study aimed to evaluate the safety and short-term effect of contemporaneous surgeries (bariatric surgery plus uvulopalatopharyngoplasty [UPPP]) in the treatment of morbid obesity comorbid with severe obstructive sleep apnea (OSA)., Methods: A retrospective cohort study was performed to identify patients with obesity and severe OSA who underwent laparoscopic sleeve gastrectomy (LSG) with or without UPPP surgeries between December 2019 and December 2021 in our center. Patients were divided into 2 groups according to different surgical methods (contemporaneous group [LSG with UPPP] vs LSG-only group). Data about surgical safety, OSA remission, and effectiveness of weight loss were collected and analyzed between the 2 groups before and 12 months after surgery., Results: A total of 101 patients were included in this study (contemporaneous group [LSG with UPPP], n = 42 vs LSG only group, n = 59). There was no significant difference in surgical safety between the 2 groups, and both OSA and obesity were significantly improved at 12.5 ± 2.1 months postoperative follow-up. The apnea-hypopnea index decreased from 68.7 ± 30.4 events/h to 10.2 ± 7.0 events/h in the contemporaneous group ( P < .001) and from 64.7 ± 26.2 events/h to 18.9 ± 9.8 events/h in the LSG group ( P < .001). Moreover, the apnea-hypopnea index decreased to below 5 events/h in 50% of patients (21/42) in the contemporaneous group but only in 13.5% of patients in the LSG group ( P < .001). In the LSG group 20 (34%) patients achieved a reduction in apnea-hypopnea index < 15 events/h and resolution of daytime sleepiness., Conclusions: Contemporaneous surgery (concurrent bariatric and UPPP surgeries) is feasible and an effective option for patients with obesity and severe OSA. However, our finding suggests that approximately a third of patients undergoing LSG with UPPP may not derive significant benefit from the UPPP portion of the contemporaneous surgical approach., Citation: Yang C, Yu W, Yao K, et al. Concurrent laparoscopic sleeve gastrectomy with uvulopalatopharyngoplasty in the treatment of morbid obesity comorbid with severe obstructive sleep apnea: a retrospective cohort study. J Clin Sleep Med . 2024;20(4):555-564., (© 2024 American Academy of Sleep Medicine.)