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Objectives/hypothesis: To evaluate the effect of radiofrequency surgery of the soft palate on daytime sleepiness in snoring men with mild or no sleep apnea., Study Design: Randomized controlled trial., Methods: Thirty-five men were recruited from consecutive patients referred to the Ear, Nose, and Throat Clinic due to snoring and complaints of daytime sleepiness. The inclusion criteria were an apnea-hypopnea index (AHI) of ≤ 15, male gender, and age 18 to 65 years. Patients were randomized to either radiofrequency or sham surgery of the soft palate. All but one chose and received the option of three treatments. All patients participated in a follow-up, including an overnight sleep apnea recording and questionnaires 12 months after the last treatment. The primary outcome was daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) and other questionnaires. Secondary outcomes were effects on the AHI and subjective snoring., Results: Thirty-two of 35 patients-19 of 20 patients in the radiofrequency surgery group and 13 of 15 patients in the sham surgery group-completed the study. No differences between the two groups in relation to the ESS or AHI were found at follow-up., Conclusion: Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring, or apnea frequency in snoring men with mild or no sleep apnea 1 year after surgery., Level of Evidence: 1b. Laryngoscope 124:2422-2426, 2014., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: With the idea of "replacing lost tissure with similar tissure in kind", vessel-pedicled palate mucosal flap, pedicled buccal musculomucosal flap and adjacent tongue musculomucosal flap could be the ideal approaches to soft palate reconstruction., Aim: To assess the adjacent tongue musculomucosal flap for soft palate reconstruction., Patients and Methods: From August 2010 to July 2011, we applied tongue musculomucosal flap for soft palate reconstruction in three patients with Obstructive Sleep Apnoea/Hypopnoes Syndrome (OSAHS) in order to release OSAHS symptom by glossal volume reduction., Results: All patients recovered from intraoral operations with good objective as subjective speech and swallowing. Suffice it to say that OSAHS symptom was released for these patients., Conclusions: Here we provide a case to deal with problems related to OSAHS symptom when one works on oral surgery or reconstructing oral structure.

The objective of this randomized, controlled study is to compare intraoperative blood loss, operative time, postoperative pain and postoperative adverse effects (bleeding, velopharyngeal insufficiency and others) between vessel sealing system uvulopalatoplasty (VSSU) and uvulopalatal flap (UPF). The study was conducted at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 31 subjects with sleep-disordered breathing and obstruction at the retropalatal level were enrolled consecutively. Intervention was randomized by mixed block randomization into 2 groups (UPF, VSSU). Stratification was also done by the presence or absence of concomitant tonsillectomy. Measured outcomes, which were blinded to patients and outcome assessor, were intraoperative blood loss, operative time, postoperative pain, postoperative bleeding, postoperative velopharyngeal insufficiency and other adverse effects. Median (IQR) of intraoperative blood loss from VSSU and UPF was 0.00 (0.00-1.00) and 6.00 (1.25-12.75) ml (p < 0.001). Median (IQR) of operative time from VSSU and UPF was 3.50 (3.00-5.00) and 15.00 (12.25-18.00) min (p < 0.001). There was significantly less pain in VSSU group on operative day (p = 0.001) and postoperative day 1 (p = 0.009). However, no significant difference of pain on postoperative day 2 to day 14 (p = 0.055-0.983) between both groups. Regarding postoperative bleeding, 1 case of immediate bleeding in UPF group and 1 case of delayed bleeding in VSSU group were found in this study. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups. In conclusion, VSSU was better than UPF in terms of less intraoperative blood loss, less operative time and less pain in early postoperative period. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups.

Objective: To characterise the appearance of lesions of the tongue base and soft palate induced by bipolar radiofrequency volumetric tissue reduction, using magnetic resonance imaging up to six weeks post-procedure., Methods: Five men with sleep-disordered breathing were treated with one session of bipolar radiofrequency volumetric tissue reduction to a number of sites, including the tongue base and soft palate. Magnetic resonance imaging was performed pre-operatively and one week and six weeks after surgery., Results: Lesions were visible from day one. T1 (spine lattice relaxation Time)-weighted images demonstrated areas of central hyperintensity, reflecting haemorrhagic, coagulative necrosis, surrounded by hypointensity, representing oedema; corresponding short tau inversion recovery (STIR) sequences showed central hypointensity with surrounding high signal. The lesions expanded up to day three and then gradually diminished, but were still evident at week six on short tau inversion recovery images., Conclusion: The characterisation of lesions induced by bipolar radiofrequency volumetric tissue reduction enables us to elucidate the pathophysiology of this procedure, to optimise treatment benefits and clinical outcomes, and to explain patient symptoms.

Objectives: In this study the efficacy of palatal implants for treatment of snoring was evaluated., Patients and Methods: Seventeen patients (10 males, 7 females; mean age 49.2+/-7.8 years; range 31 to 66 years) with primary snoring and an apnea-hypopnea index of less than 15 were treated with palatal implants after clinical and endoscopic examination. Snoring-related symptoms were evaluated at baseline and 90 days after surgery and polysomnography was performed. Patients and their spouses completed questionnaires and visual analog scales (VAS) evaluating snoring, apneas, and the intensity, duration, and social effects of daytime sleepiness at baseline and 90 days after surgery. Pre- and postoperative assessment results were compared., Results: Epworth sleepiness scale score was significantly decreased in the postoperative period (p<0.05). Postoperative mean VAS snoring, apnea, and daytime sleepiness scores were also significantly improved (p<0.01). No patients reported worsening of apnea, 5.9% of patients reported no change in apnea, and 94.1% of patients reported a marked decrease in apneas. In the postoperative period, 76.4% of patients reported reduced snoring, and 88.3% of patients reported reduced daytime sleepiness., Conclusion: Palatal implants have been demonstrated to be a safe and effective treatment for snoring with minimal patient discomfort. Establishing realistic pretreatment expectations can maximize patient satisfaction.

Background and Objectives: Snoring and apnea are social and medical problems that affect as many as 2% of adult women and 4% of adult men. This study compares collagen distribution and type with the intensity of snoring and the degree of drowsiness following uvulopalatoplasty with CO2 laser and radiofrequency ablation., Study Design, Patients, and Methods: Fragments were taken from the soft palate by biopsies of 16 uvulopalatoplasty patients and 5 controls, 5 weeks after surgery, and they were stained with Sirius red and observed with polarization microscopy. Photographs were taken, and the type and changes in the amount of collagen before and after surgery were compared., Results: A histological analysis 5 weeks postoperatively in 10 patients showed an increased amount of collagen and replacement of type III collagen with type I collagen., Conclusions: The increase in the amount of collagen after uvulopalatoplasty was significantly larger in patients than in the controls, and all changes from type III to mostly type I collagen occurred in patients who had the surgery. The subjective improvement of both snoring and somnolence is associated with this increase in type I collagen.

Introduction: There is abundant conflicting information in the literature about prognostic value of sophisticated, diagnostic tests as well as data from simple clinical examination in its surgical treatment due to the complex nature of OSA. The aim of our study was to assess the efficacy of uvulopalatopharyngoplasty in the treatment of mild and moderate OSA patients who were preliminary selected by simple clinical examination., Material and Method: 20 patients with obstructive sleep apnea syndrome were included in this study. There were patients who met the following criteria: RDI less than 30, BMI less than 30, collar size less than 43 cm, normal nasal potency, modified Mallampati grade I or II, were enrolled in the study. The mean age of the patients was 45,5. Modified Mallampati score was used for evaluation the structures of oropharynx., Results: 55% of patients were classified for grade I in Mallampati score and 45% of patients- grade II in this scale. At least 50% reduction of RDI after UPPP was observed in 75% of patients. The mean RDI was decreased from 21,35 in preoperative period to 9,85 in the control study. In 60% of our patients the RDI dropped to the value of less then 10. In 5% of the patients, the surgical treatment did not decrease at least 50% of RDI. However in this patient group, we observed a slight improvement of mean minimal saturation (from 84,1 +/- 3,8 to 86,2% +/- 3,6)., Conclusion: Using simple clinical parameters for preliminary selection of patients with mild and moderate OSA enabled us to achieve considerably better success rate after UPPP.

Objective: Tongue base surgery in the severe OSA patients may improve the success of uvulopalatopharyngoplasty (UPPP) as the collapse is multilevel. The aim of this study was to evaluate the long-term objective and subjective effectiveness of the minimally invasive tongue base suspension combined with UPPP in severe OSA patients., Study Design and Setting: We conducted a retrospective analysis of 22 OSA patients undergoing UPPP and the tongue base suspension for the treatment of severe OSA., Results: Twenty-two men who had their preoperative and postoperative polysomnography had a 54% reduction in the preoperative Respiratory Disturbance Index (RDI), from 47.50 +/- 15.74 to a level of 17.31 +/- 14.17. The standard surgical cure rate which is a >50% reduction in the RDI and a postoperative RDI of <20 events/hour was 81.81%. All patients had some degree of subjective improvement in their snoring, daytime sleepiness, and the Epworth sleepiness scale., Conclusions: The tongue base suspension combined with UPPP has been shown to reduce RDI better than UPPP alone. This minimally invasive technique is highly successful at 81.81% when combined with UPPP in the severe OSA patients with multilevel airway collapse., Significance: This study shows the benefits of minimally invasive tongue base suspension combined with UPPP in severe obstructive sleep apnea syndrome.

Objective: Uvulopalatopharyngoplasty (UPPP) success rates in patients classified with Friedman stage 3 is reported as 8%. Surgical failure may result from persistent obstruction at the palate, which may be addressed by pharyngoplasty with palatal advancement (PA). The effectiveness of PA versus UPPP was evaluated by using polysomnographic outcomes in a retrospective cohort of patients classified with Friedman stage 3., Methods: Surgical records were reviewed for PA (n = 47) and UPPP (n = 124). Clinical records were reviewed and reclassified by Friedman stage. Respiratory data were collected from overnight polysomnography. Statistical analysis was conducted of continuous variables (ANOVA), categorical variables (chi2), and adjusted odds ratios by using logistic regression., Results: PA (n = 30) and UPPP (n = 44) did not differ in baseline apnea hypopnea index (AHI), age, or BMI. Both PA (48.3 +/- 24.6 to 19.8 +/- 16.8 events per hour, P < 0.000) and UPPP (47.9 +/- 30.0 to 30.9 +/- 24.2 events per hour, P < 0.000) improved with surgery. In the PA group, final AHI was lower (17.1 +/- 30.1 versus 28.5 +/- 25.6, P < 0.04) and postoperative change was greater (30.9 +/- 24.2 versus 19.8 +/- 16.8, P < 0.02). For patients with Friedman stage 3, odds ratio of having an AHI of <20 events per hour and a greater than 50% reduction with PA compared with UPPP was 3.80 (95% CI, 1.41-10.29, P < 0.013). Adjusted for age, body mass index, preoperative apnea severity, and tongue-base surgery, OR was 5.77 (95% CI of 1.80-17.98)., Conclusions: Polysomnographic outcomes using AHI support the use of palatopharyngoplasty using palatal advancement as an effective treatment of obstructive sleep apnea. PA may offer benefit over UPPP alone in patients classified with Friedman stage 3.

Objectives: To investigate the incidence of complications after temperature-controlled radiofrequency (TCRF) treatment of the inferior turbinates, palate, and tongue. To compare these complication rates with those reported in the literature., Study Design: Prospective, observational study., Methods: All patients treated with TCRF to the inferior turbinates, palate, and tongues during a 12-month period were included. Data were collected for parameters of energy delivery and the development of complications., Results: One hundred thirty-six patients were treated with a total of 470 TCRF lesions. The overall incidence of minor complications was 1.2% (6/470 lesions); there were no complications of moderate or major severity., Conclusion: The incidence of minor complications after TCRF in this series was low, and there were no complications of greater severity. These findings are in stark contrast with some previously published papers with higher complication rates. These significantly higher rates may be caused by a marked learning curve, problems in patient selection and the technique of application, excessive energy delivery, and perioperative management.

Background: The present study was undertaken in an effort to assess the use and the efficacy of an innovative radiofrequency system (RaVoR, Select-Sutter, Freiburg i. Br.) and the bipolar electrodes conceived by the author for the treatment of habitual, disruptive snoring. The author's own surgical method takes into account a number of published retrospective studies on radiofrequency application in the treatment of snoring and is based on important anatomical, physiopathological and histological knowledge., Patients and Methods: Thirty-one patients diagnosed with primary snoring and five patients with associated sleep apnea syndrome (SAS) were treated according to the method and with the RaVoR system in the past three years. The intensity as well as the snoring density was assessed on a numeric analogue scale (NAS; ranging from 0 = "patient doesn't snore anymore" to 4 = "patient continues to snore as before"), which was filled out by the partner preoperatively and postoperatively after 6 months and 2 years., Results: Snoring was reduced in 31 (86 %) patients (NAS

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by episodic decrements in airflow due to upper airway obstruction. Uvulopalatopharyngoplasty (UPPP) is a potential therapy for OSAHS. Nasopharyngeal stenosis is a rare complication of UPPP that worsens OSAHS. We report two patients referred for OSAHS worsened by nasopharyngeal stenosis complicating UPPP. Both patients were treated with carbon dioxide laser release of adhesions and placement of a nasopharyngeal obturator. Follow-up polysomnograms demonstrated resolution of OSAHS correlating with subjective resolution of symptoms. Nasopharyngeal stenosis complicating UPPP can be successfully treated with scar removal and nasopharyngeal stenting. Polysomnographic demonstration of the effectiveness of this therapy has not previously been reported. Future questions include duration of nasopharyngeal stenting and timing of follow-up polysomnography.

There is no consensus on how to quantify the abnormality of upper airway structures in patients with obstructive sleep apnea (OSA). This research aimed to use morphological indicators as clinical predictors to correlate morphological stage and surgical results in OSA patients. One hundred and five patients with OSA received palatopharyngeal surgery, i.e. extended uvulopalatal flap (EUPF). Morphological indicators including modified Mallampati grade (MMP), tonsil size, and body mass index were used to stage OSA patients preoperatively. Change of respiratory disturbance index (RDI) was used to monitor change of sleep apnea events. Success rates were compared among patients of different morphological stages. One year after EUPF, the success rates of EUPF in stage I, II, and III patients were 100, 92.9 and 61.4%, respectively. Change of RDI was significantly correlated with MMP and tonsil size. MMP and tonsil size were predictive of the change of RDI (R(2) = 0.29). Morphological stage may serve as a reliable selection criterion for patients undergoing EUPF surgery and can significantly predict the change of sleep apnea events following EUPF surgery., (Copyright 2004 S. Karger AG, Basel)

Objectives: This study compares the efficacy of 2 tongue-base surgical procedures in the treatment of patients with moderate to severe sleep-disordered breathing., Study Design and Setting: We conducted a prospective, randomized crossover surgical trial at a university hospital., Methods: Seventeen patients with moderate to severe sleep-disordered breathing and Fujita type II upper airway collapse for whom conservative treatment failed were enrolled into an institutional review board-approved surgical protocol. They were randomly assigned to undergo palatopharyngoplasty combined with either tongue advancement (mandibular osteotomy) or tongue suspension. Parameters assessed included severity of sleep-disordered breathing (polysomnography), sleepiness (Epworth Sleepiness Scale), and anatomic changes (upper airway endoscopy), as well as demographic factors. Patients not achieving satisfactory improvement in their condition were offered nonsurgical management or additional surgical treatment that varied based on the postoperative assessment but included crossing over to the other tongue surgical procedure., Results: Nine of the 17 patients were randomized to the tongue suspension group, and 8 to the tongue advancement group. In the 9 tongue suspension patients, Epworth Sleepiness Scale scores fell from 12.1 to 4.1 (P = 0.007). Airway collapse for all 9 patients measured on Müller maneuver improved, by a mean of 64% (P = 0.0006) at the palate and 83% (P = 0.0003) at the base of the tongue. In the 8 tongue advancement patients, Epworth Sleepiness Scale scores fell from a mean of 13.3 to 5.4 (P = 0.004). Airway collapse for 5 of 8 patients measured on Müller maneuver improved by a mean of 31% (P = 0.1) at the palate and 75% (P = 0.03) at the base of the tongue., Conclusion: Prospective, randomized trials of tongue-base surgery for sleep-disordered breathing are possible. Preliminary findings from the current protocol reveal a slight advantage of tongue suspension over tongue advancement.

Objective: Our goal was to investigate the correlation between upper airway 3-dimensional computed tomography (3-D CT) measurements and polysomnography data of patients with sleep-disordered breathing (SDB). Study design and setting The 3-D CT scan measurements of the retropalatal space (RP), lateral and anteroposterior diameters of RP, retroglossal space, uvular thickness, and volume of upper airway were taken prospectively from 194 consecutive SDB patients. These were correlated with patients' respective Respiratory Distress Index (RDI), snoring index, and lowest arterial oxygen saturation gathered from polysomnographic data., Results: RP (r = -0.27, P = 0.0001) and lateral diameter (P = 0.0073) were significantly correlated with RDI. Multivariate regression model (R(2) = 0.286) demonstrates RP (P = 0.0036) and retroglossal space (P = 0.027) to be predictive of RDI. No 3-D CT parameters correlated with snoring index and lowest arterial oxygen saturation attained statistical significant., Conclusion: The 3-D CT scan measurements can be valuable in evaluating upper airway patency in patients with SDB. The RP was the most relevant upper airway anatomic structure identified in these patients., Significance: Modification of palatal surgery to increase the lateral dimension of the RP may be a breakthrough in increasing its success rate.

Objective: Temperature-controlled radiofrequency volumetric tissue reduction (RFVTR) is a minimally invasive technique used in the treatment of the tongue base, soft palate and turbinates. Complications seem to be rare, but the scope of previous studies was often limited by the small number of patients included. The aim of this study was to evaluate postoperative complications in a large series of patients., Material and Methods: In this retrospective study, temperature-controlled radiofrequency procedures (Somnoplasty) performed between May 1998 and March 2002 were considered. The charts of the patients were analyzed with regard to intra- or postoperative complications., Results: In total, 322 patients received 497 treatment sessions; 239 of these treatments were isolated and the remaining 258 were combined procedures. Mean follow-up was 122.8 +/- 145.5 days. Concerning radiofrequency surgery, nine postoperative complications were observed (2.0%) as follows: ulcerations of the tongue base or soft palate; dysphagia necessitating hospital admission; temporary palsy of the hypoglossal nerve; and an abscess of the base of the tongue., Conclusions: Complications occurring after RFVTR are infrequent and mostly mild. Overall, temperature-controlled RFVTR is a safe procedure when used both in isolation and as part of a combined approach.

Objectives: We compared the efficacy of 2 palatal surgical procedures in the treatment of patients with mild sleep-disordered breathing (SDB)., Study Design and Setting: We conducted a prospective, randomized, crossover surgical trial at a university hospital., Methods: Twenty patients with mild SDB for whom conservative treatment failed were identified and consecutively enrolled into an institutional review board-approved surgical protocol. They were randomly assigned to undergo either radiofrequency ablation of the palate (RFAP) for a planned 3-stage treatment or laser-assisted uvulopalatoplasty (LAUP), also for 3 stages of treatment, using a CO(2) laser. Parameters assessed included severity of SDB (polysomnography), subjective and objective loudness of snoring (visual analog scale and SNAP recording), sleepiness (Epworth Sleepiness Scale), and anatomic changes (upper airway endoscopy), as well as demographic factors. Patients not achieving satisfactory improvement in their condition were crossed over to the alternative surgical therapy for attempted salvage., Results: Seventeen of the enrolled patients have completed the protocol. Ten of these were randomized to the RFAP group, and 7 to the LAUP group. Six of the RFAP patients (60%) achieved a satisfactory resolution of their snoring, and 4 failed and were salvaged with LAUP. Six of the LAUP patients (86%) achieved a satisfactory resolution of their snoring, and 1 patient failed and was salvaged with nasal surgery. One patient who was initially cured had a relapse after 9 months and was successfully salvaged with RFA., Conclusion: Prospective, randomized trials of surgery for SDB are possible. Preliminary findings from the current protocol reveal a slight advantage of LAUP over RFAP but with a greater degree of discomfort postoperatively.

Sleep-disordered breathing (SDB) affects more than 4% of the adult population with an even higher prevalence within high-risk groups. Nasal continuous positive air pressure, although considered the current gold standard treatment for SDB, demonstrates poor patient compliance. Alternative therapies, such as palatal surgeries and airway orthotics, lack validated candidacy selection protocols, resulting in varying success rates. Although much has been published over the last several years regarding the effect of these therapies on the upper airway, no publication has presented an accounting of the use of acoustic reflection (AR) to evaluate airway characteristics pre- and post-treatment with these alternative therapies. This article will review AR and our current knowledge base of the pathological airway characteristics that can be assessed through AR. It will include the advantages, limitations, and potential clinical usefulness of this diagnostic modality in the treatment of patients with SDB.

Objectives: We evaluated the efficacy of laser-assisted uvulopalatoplasty in the treatment of snoring and obstructive sleep apnea syndrome (OSAS)., Patients and Methods: Laser-assisted uvulopalatoplasty was performed in 34 patients (30 males, 4 females; mean age 45.7 years; range 17 to 70 years) with simple snoring and mild OSAS. The patients were evaluated preoperatively and in the first and sixth months postoperatively with the use of the Epworth sleepiness scale, polysomnography, and snoring scores. A questionnaire was administered to assess patient satisfaction., Results: All patients had decreased snoring. The quality of sleep increased in 79%. The clinical improvement seen in the first month continued through the sixth postoperative month. Satisfaction rates for the patients and their families were 88% and 85%, respectively. Significant decreases were found in the Epworth sleepiness scale (p=0.000) and visual snoring scores (p<0.001). In addition, postoperative desaturation indices decreased and minimal desaturation levels increased. However, no significant decreases occurred in the apnea/hypopnea index. No complications were encountered during and after operation., Conclusion: Laser-assisted uvulopalatoplasty has high efficacy in the treatment of snoring and mild OSAS, with such additional advantages as ease, low complication rate, and no need for hospitalization.

In the years 1996-1999 in the Department of Otolaryngology of Medical Academy in Warsaw 58 patients with respiratory disorders during sleep were treated using uvulopalatoplasty in 35 cases and laser uvulopalatoplasty in 23 cases. The authors describes operation technique, qualification criteria and results assessed on the basis of basic values of polysomnographic study as well as subjective feelings of patients.

Laser-assisted uvulopalatoplasty (LAUP) is an outpatient surgical procedure which is in use as a treatment for snoring. LAUP also has been used as a treatment for sleep-related breathing disorders, including obstructive sleep apnea. The Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature, and developed these practice parameters as a guide to the appropriate use of this surgery. Adequate controlled studies on the LAUP procedure for sleep-related breathing disorders were not found in peer-reviewed journals. This is consistent with findings in the original practice parameters on LAUP published in 1994. The following recommendations are based on the review of the literature: LAUP is not recommended for treatment of sleep-related breathing disorders. However, it does appear to be comparable to uvulopalatopharyngoplasty (UPPP) for treatment of snoring. Individuals who are candidates for LAUP as a treatment for snoring should undergo a polysomnographic or cardiorespiratory evaluation for sleep-related breathing disorders prior to LAUP and periodic postoperative evaluations for the development of same. Patients should be informed of the best available information of the risks, benefits, and complications of the procedure.

Purpose: This study evaluated the effectiveness of uvulopalatopharyngoplasty (UPPP) with mortised genioplasty and maxillomandibular advancement (MMA) for the treatment of patients with obstructive sleep apnea not controllable with appliances or continuous positive airway pressure., Methods: Forty patients with obstructive sleep apnea were evaluated retrospectively. Thirty-three patients underwent combined UPPP and a modified mortised genioglossus advancement. Patients who had specific indications for MMA underwent combined procedures, eliminating staging of multiple surgeries. Seven patients were in this group. All patients were evaluated preoperatively and postoperatively with polysomnography to evaluate the efficacy of the treatment., Results: Mean respiratory distress indices (RDI) and nadir oxyhemoglobin desaturation values were significantly improved with each of the therapies despite many patients having body mass indices significantly greater than the average quoted in other studies. Patients with moderate sleep apnea (RDI, 21 to 40) who underwent UPPP/genioglossus advancement did very well, with 86% of patients achieving success. Patients who underwent MMA all decreased their RDI by at least 56% and had an average improvement of 86%., Conclusions: The UPPP/mortised genioglossus advancement is effective for the treatment of obstructive sleep apnea. Maxillomandibular advancement is effective for treating severe sleep apnea and may, in some cases, be indicated in combination with UPPP/mortised genioglossus advancement to avoid multiple procedures. Surgical reconstruction of the upper airway is a reasonable approach to the treatment of patients with obstructive sleep apnea, and can be approached more directly to minimize repeated surgical intervention., (Copyright 2001 American Association of Oral and Maxillofacial Surgeons)

Laser Assisted Uvulopalatoplasty (LAUP) the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome was first performed by Kamami in 1988. LAUP can reduce the airway obstruction in the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. From 1998 to 2000 37 patients underwent LAUP in our ENT Department in Zabrze. This group comprised of 19 OSA patients and 18 habitual snorers. In cases of nasal obstruction by turbinate hypertrophy or septal deviation we performed septoplasty or partial inferior turbinectomy by laser CO2. In some cases with palatin or lingual tonsils hypertrophy we also performed tonsillectomy or lingual tonsil laser ablation. In 5 patients LAUP was performed in several stages. Before and after the surgical treatment each patient were evaluated by PolyMESAM--the device belongs to the third diagnostic level. In all postoperative evaluated OSA patients the RDI decreased significantly. In 4 patients (50% of evaluated after LAUP patients) the RDI dropped to 10 or lower. Snoring was eliminated or significantly reduced in 83% of patients classified as the habitual snorers. No serious complications were observed. LAUP is a good alternative to UPPP in the surgical treatment of habitual snorers and some of the patients with OSA syndrome.

Objective: The objective of this study is to evaluate the management of nasopharyngeal stenosis (NPS) with the CO(2) laser and a customized nasopharyngeal obturator., Study Design: An 8-year retrospective study based at a tertiary care teaching hospital consisting of 18 patients with NPS after uvulopalatoplasty treated over an 8-year period with the CO(2) laser and a nasopharyngeal obturator. Patients with grade I stenosis were treated in the office and did not require a nasopharyngeal obturator. More severe cases (grades II and III) were treated in the operating room and required a nasopharyngeal obturator., Results: Eighteen patients with NPS, stages I to III, were treated with a CO(2) laser with or without a nasopharyngeal obturator with good results., Conclusion: The repair of NPS with a CO(2) laser and a nasopharyngeal obturator in severe cases helps in restoring nasopharyngeal patency., Significance: This technique provided a reliable method of correcting postuvulopalatoplasty NPS.

Objective: To study the surgical treatment for the recurrent patients after palatopharyngoplasty (PPP)., Method: Five patients which were confirmed recurrence by sleep survey and examinations were reported., Result: The pharyngeal cavity was narrower obviously ten months after ppp than before ppp. The anteroposterior and transverse distances were (4.06 +/- 2.94) mm and (11.40 +/- 4.16) mm respectively. After dilatation, the distances were (11.90 +/- 3.25) mm and (21.00 +/- 4.18) mm separately, and were increased significantly than before (P < 0.01). Two patients were cured and three cases marked, and all patients were not recurrent post-operation with no complications., Conclusion: The recurrence was mainly concerned with the unsuitable manipulation in PPP. Selecting the cooperation and proper surgical treatment, the better effect was also obtained for the recurrent patients.

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 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.

Objectives: Assessment of the long-term effect of uvulopalatopharyngoplasty (UPPP) on snoring, excessive daytime sleepiness, and nocturnal oxygen desaturation index (ODI) in patients with obstructive sleep apnea syndrome., Study Design: Evaluation of snoring, excessive daytime sleepiness, and ODI in patients treated by UPPP earlier., Materials and Methods: Patients (n = 58) with a follow-up period of 11 to 74 months (median, 34 mo) were included in this study. Snoring and excessive daytime sleepiness were scored on specially designed semiquantitative scales. In all patients ODI was calculated from pulse-oximetry combined with polysomnography at base line and by polygraphy (MESAM 4) during follow-up in 38 patients. Long-term response was compared with 6-month response in the same cohort., Results: There was a long-term improvement of snoring in 63% of patients, no change in 23%, and a deterioration in 14% (P < .00001). Overall snoring increased slightly between 6 months and long-term follow-up. There was an improvement of excessive daytime sleepiness in 38%, no change in 27%, and a deterioration in 35% (P = .80). Excessive daytime sleepiness showed a relapse to preoperative levels between 6 months and long-term follow-up. The median improvement of ODI was -1 (95% interpercentile range, 73-51) and was not significant (P = .35). In 5 of 13 patients in whom ODI at baseline exceeded 20, ODI was reduced to less than 20. In 4 of the 38 patients ODI was reduced to less than 5. The improvement of ODI decreased significantly between 6 months and long-term follow-up (P = .03). No relation was found between body mass index, Mueller maneuver, X-cephalometry, and long-term outcome. An additional finding was that the ODI decreased after UPPP in combination with tonsillectomy, compared with a slight increase after UPPP alone; the difference was significant (P = .008)., Conclusion: The response to UPPP for obstructive sleep apnea syndrome decreases progressively over the years after surgery. UPPP in combination with tonsillectomy was more effective than UPPP alone.

Objectives: Palatal musculature is known to be responsible for the active opening of the eustachian (auditory) tube. Because laser-assisted uvulopalatoplasty (LAUP) may involve partial division of these muscles, the effect of this procedure on middle ear pressures (MEPs) and middle ear volumes (MEVs) was investigated., Study Design: A controlled interventional trial with one limb receiving treatment and the other none. Preoperative and postoperative measurements were carried out in both groups., Methods: A control group of 15 normal volunteers and a study group of 22 patients undergoing LAUP all of whom had normal ears and type A tympanograms before the trial were recruited. Repeat tympanometry was carried out after 3 months in both groups. The results of MEP and MEV were recorded for both groups and analyzed by the Mann-Whitney U test., Results: A trend toward reduced MEP and MEV was noted in the LAUP group, but did not achieve statistical significance. A study with more patients may achieve significance., Conclusions: No significant effects on middle ear pressures or volumes 3 months after LAUP were demonstrated. A much larger study may, however, arrive at a statistically significant result and further work is warranted. Relevant palatal and tubal anatomy is discussed and a brief review of the relevant literature is given.

Objective: To determine whether perioperative systemic corticosteroid administration can reduce uvulopalatopharyngoplasty (UPPP) postoperative morbidities (e.g., pain, anorexia, sleep disturbance, mouth odor, and fatigue) or reduce narcotic analgesic usage., Study Design: A prospective, double-blinded study with random assignment of treatment agent (placebo or corticosteroid)., Methods: From 1995 to 1998, a consecutive sample of 48 adults presenting for elective UPPP surgery alone or in combination with tonsillectomy or septoplasty, or both, were enrolled. Twenty-eight subjects completed the protocol and were equally distributed by random assignment to intramuscular (IM) and intravenous (IV) doses of placebo (saline) or corticosteroid (60 mg methylprednisolone IM and 12 mg dexamethasone IV). Acetaminophen with codeine analgesic was available to both groups as needed. Subjects recorded a diary of symptom severity scores over the first postoperative week relating to eight commonly reported morbidities (1-4 points) and the daily quantity of narcotic consumed., Results: Statistical comparison (Wilcoxon's rank sum test) showed no significant differences between subjects treated with placebo or corticosteroid on postoperative day 1 or 7. Three subjects (21%) in each treatment group reported no postoperative use of narcotic analgesic., Conclusions: No statistically or clinically significant benefits were derived from perioperative systemic corticosteroid treatment in this sample of 28 adults treated with UPPP alone or in combination with tonsillectomy or septoplasty, or both. Some individuals tolerate post-UPPP discomfort without a narcotic analgesic.

Objectives/hypothesis: To examine the long-term results of laser-assisted uvulopalatoplasty (LAUP) for the treatment of patients with obstructive sleep apnea syndrome (OSAS)., Study Design: One hundred eighty-two OSAS patients treated with LAUP were followed for an average of 4 years. Of these patients, 131 have completed treatment. Complete polysomnographic data are available on 48 patients. Five patients were eliminated owing to nasal surgery performed during the period between the preoperative and postoperative sleep studies, thus 43 patients were included who had only LAUP treatment. Another three patients were eliminated because their postoperative polysomnograms were performed less than 6 weeks after the last procedure. Complete long-term subjective data are available on 31 patients., Methods: Between July 1993 and July 1998, 1038 patients were evaluated for LAUP treatment for snoring and OSAS. Of the 1038 patients, 409 were treated with LAUP and the remaining 629 were treated with other surgical procedures, devices, or behavior modification. The 40 patients who underwent only LAUP treatment for OSAS and have complete polysomnographic data are the focus of this study., Results: The significant objective polysomnographic findings include a decrease in the respiratory disturbance index (RDI) from 25.0 +/- 2.8 to 15.3 +/- 2.9 (P = < .0001), and a decrease in the apnea index (AI) from 14.6 +/- 2.6 to 9.0 +/- 2.4 (P = .00248). In addition, the percentage of time spent in rapid eye movement (REM) sleep significantly increased after LAUP, from 13.3% +/- 1.0 to 17.6% +/- 1.4 (P = .0149). The long-term subjective results indicate that the presenting complaints were improved after LAUP in 74.9% +/- 4.1 with a mean follow-up of 4.04 years +/- 72 days (median, 4.63 y)., Conclusions: LAUP remains a safe and effective treatment for carefully selected patients suffering from OSAS. Five years after LAUP was introduced in the United States, objective polysomnographic data demonstrate reduction in the RDI and increased time spent in REM sleep after treatment. In addition, the long-term subjective results show that the presenting symptoms were no longer present in 75% of patients treated with LAUP.

Objective: To assess late histopathologic changes of the soft palate after laser-assisted uvulopalatoplasty in patients with snoring and mild obstructive sleep apnea., Design: A nonrandomized, histopathologic controlled study., Subjects and Interventions: Palatal surgical specimens were removed from 10 patients with snoring and obstructive sleep apnea in whom laser-assisted uvulopalatoplasty was not successful and who subsequently underwent uvulopalatopharyngoplasty. The mean interval between the last laser treatment and uvulopalatopharyngoplasty was 24 months. The patients' specimens were compared with those of a control group consisting of 12 palates and uvulae excised during uvulopalatopharyngoplasty., Results: After laser-assisted uvulopalatoplasty, all soft palates displayed marked and progressive pathologic changes that increased with every additional treatment and extended far beyond the point of laser beam application. The loose connective tissue present in the lamina propria was replaced by diffuse fibrosis, which also extended to the central layer, on the expanse of seromucous glands and muscle fibers. Other changes included ulceration of the oral epithelium and a patchy inflammatory reaction., Conclusions: Extensive thermal-induced changes, involving the 3 layers of the organ, were found. They are compatible with clinical observations reported elsewhere and are probably responsible for the worsening of the obstructive sleep apnea status and the sensation of the pharyngeal dryness that developed months after the laser-assisted uvulopalatoplasty. Although it has immediate benefits, the procedure is still relatively new and all its implications are as yet unknown.

This paper presents the long-term effect of restricted surgery for snoring and sleep apnoea. Patients with obstructive sleep apnoea (OSAS) (19) or heavy snoring (HS) (36) were studied prospectively for five to seven years after uvulopalatopharyngoplasty without tonsillectomy performed by regular surgical technique using local anaesthesia (LUPP). Five years after surgery, 90 per cent answered a questionnaire. All OSAS patients were offered a polysomnography, and the HS patients were offered a sleep study. Eighty per cent still showed a positive effect on daytime somnolence, and 77 per cent on snoring. Side-effects were reported by 40 per cent; most common was choking (20 per cent) the first year. Eighteen per cent had local problems such as globus sensation. The polysomnography showed that 80 per cent were still 'responders' with an apnoea index (AI) reduction of > 50 per cent. None of the HS patients had developed OSAS. In conclusion, LUPP in selected patients with OSAS or HS has a good long-term effect. Side-effects are common, but diminish with time.

Before the invention of CPAP therapy, the only effective surgical treatment for obstructive sleep apnea syndrome was tracheotomy. Now, surgical approaches mainly focus on two anatomical sites. Each procedure influences either the retropalatal or retrolingual portion of the pharynx. They might be applied individually, synchronously with other procedures, or sequentially with other therapeutic devices. Common methods of velar surgery include uvulopalatopharyngoplasty (UPPP), Laser-assisted uvuloplasty (LAUP), radiofrequency or uvulaflap. These techniques are indicated mainly in patients with mild OSAS. Other procedures focus on the posterior airway space (PAS), including operations that reduce the volume of the tongue or base of tongue. In selected patients, an enlargement of the retrolingual airway is gained by osteosynthetic techniques. Improvement of the nasal airway passage is gained by performing a septoplasty and/or conchotomy. In this paper, the different methods and their indications for surgical therapy will be explained and the results are summarized.

Objective/hypothesis: To investigate whether body mass index (BMI) can be used to predict subjective improvement of snoring after laser-assisted uvulopalatoplasty (LAUP)., Study Design: One hundred nineteen consecutive adult patients who had LAUP performed for socially disruptive snoring were contacted by mail 3 months after surgery and asked to complete a questionnaire with the following alternatives as to the effect of surgery on their snoring: no improvement (1); some improvement (2); moderate improvement (3); substantial improvement (4) and abolished snoring (5). Patients reporting to categories 3, 4, or 5 were referred to as responders and to categories 1 or 2 as nonresponders. Seventy patients (59%) completed the questionnaire., Methods: A one-stage LAUP was performed with local anesthesia in an outpatient ear, nose, and throat clinic with a CO2 laser. Patients were divided into two categories with BMI above and below 28 kg/m2 at the time of surgery., Results: BMI correlated significantly with subjective postoperative improvement. (R = 0.29; P < .02; Pearson's correlation test). Odds ratio (OR) for success by BMI less than 28 kg/m2 compared to patients with BMI greater than 28 kg/m2 was 4.8 (95% confidence interval [CI]: 1.48-15.53)., Conclusions: BMI is a simple, yet important predictor of subjective reduction of snoring after LAUP and should be considered before performing such surgery.

The enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnoea (OSA) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. Reports on the beneficial effects of dental appliances exist, but only one prospective randomized study has been published comparing dental appliances with nasal continuous positive airway pressure (CPAP) treatment. No study has been published comparing dental appliance treatment with UPPP. Ninety-five male patients with confirmed OSA, subjective daytime sleepiness and an apnoea index (AI) > 5 were randomized for subsequent treatment with either a dental appliance or UPPP. There were 49 patients in the dental appliance group and 46 in the UPPP group. Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up. The success rate (rate of patients with at least a 50% reduction in AI) for the dental appliance group was 95%, which was significantly higher (p < 0.01) than the 70% success rate for the UPPP group. According to the criteria for OSA (apnoea index > or = 5 or apnoea/hypopnoea index > or = 10), 78% of the dental appliance group and 51% of the UPPP group were normalized after 12 months. The difference between the groups was significant (p < 0.05). These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA.

In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

We studied the effectiveness of uvulopalatopharyngoplasty under general anesthesia and classical surgery in 26 patients treated surgically for chronic snoring (CS) and obstructive sleep apnea syndrome (OSAS). Our technique is a variation of the Fujita and Quesada technique that involves partial resection of the palate and uvula with endonasal microsurgery. The criteria for inclusion were age 35 to 47 years and desire to do without C-PAP or Bi-PAP. This device, although effective, produced poor physical and psychological tolerance. After a postoperative follow-up of 3 years, good results were found in all cases.

We conducted a retrospective review of 347 consecutive patients who underwent surgical treatment for obstructive sleep apnea syndrome. We analyzed perioperative data to identify the nature and rate of complications in an attempt to determine whether intensive care unit monitoring is needed after uvulopalatopharyngoplasty (UPPP) and associated procedures including septoplasty, tonsillectomy, turbinate reduction, geniohyoid advancement, and tracheostomy. In the 347 cases, 14 complications occurred (4%), including 5 involving the airway, 5 postoperative hemorrhages, and 4 complications classed as "other," including dehiscence of a tracheostomy flap, abdominal ileus, urine retention, and increased creatinine concentration. We found no difference between preoperative lowest oxygen saturation and oxygen-saturation readings in the postoperative period and no correlation between complication rate and apnea severity. An association was detected between multiple simultaneous procedures and the development of complications: 50% of the patients in whom complications developed had undergone nasal procedures along with UPPP, compared with only 15% of the patients without complications. Except for one patient, all complications that occurred on the surgical ward were treated without transfer to the intensive care unit. Although surgery on the upper airway must be performed with caution in patients with sleep apnea, our findings suggest that UPPP is a safe procedure and that postoperative monitoring in an intensive care setting is not necessary for most patients.

The operation of Laser Assisted Uvulopalatoplasty (LAUP) as described by Kamami is now becoming more commonly used in the treatment of snoring and obstructive sleep apnoea. The authors have treated 95 snoring patients, varying the lengths of the soft palate incisions and percentage of uvula excised. All operations were carried out under general anaesthesia using a CO2 laser. Pilot studies showed incisions that are 25% of the distance between the free edge of the soft palate to the hard palate junction and excision of 50% of the uvula give good results with minimal complications. A further study using these parameters was conducted and postoperative evaluation including polysomnography confirmed this procedure to be effective in reducing snoring levels both subjectively and objectively.

Our ongoing evaluation of the results of laser assisted uvulopalatoplasty (LAUP) for snoring is presented. Follow-up between 18 and 24 months post-treatment completion, of patients with a successful result at six months, reveals that 22 per cent of these patients suffer failure of snoring control between these two evaluation points. This equates to an overall success rate at this time of 55 per cent. LAUP, like other surgical remedies for snoring, has a continued relapse rate. This must be considered when counselling patients.

Objectives: We used upper airway (UA) imaging in 20 patients to determine (1) whether an effective enlargement of the UA is obtained after uvulopalatopharyngoplasty (UPPP), and (2) whether UA modifications explain the results of such surgery., Methods: Cephalometric measurements were made to assess the posterior airway space, the length and width of the soft palate, and the distance between the hyoid bone and the mandibular plane. Pharyngeal CT measured the airway cross-sectional area (CSA) at each 10-mm slice from 10 mm above (-10) to 40 mm below (+40) the hard palate. Polysomnography was performed before and after surgery (10+/-10 [SD] months). Good responders were defined by an apnea-hypopnea index (AHI) of <10 postsurgery or, in patients in whom AHI was initially <10, a reduction of AHI >50% of the initial AHI., Results: Twenty patients (age=45+/-11 years) were studied. For the whole group, the mean body mass index (26+/-4 kg/m2) and AHI (14+/-13 vs 18+/-16/h) were unchanged after UPPP. The results of the surgery were mediocre with 7 good responders (35%) and 13 nonresponders (65%) defined by polysomnographic criteria. The only changes on UA imaging for the group as a whole after UPPP were decrease in length (40+/-6 vs 29+/-5 mm, p< or =0.0006) and increase in width of the soft palate (11.5+/-2.7 vs 13.6+/-3.5 mm, p< or =0.006). The increase or decrease in minimal CSA at the oropharyngeal (OP) level after UPPP was significantly correlated with the change in AHI (r=-0.54, p<0.02). Moreover, the changes in CSA obtained at the OP level were significant only in the patients who responded favorably to UPPP (7 vs 13 nonresponders)., Conclusions: Postoperative OP enlargement is associated with a good outcome of UPPP. Persistent narrowing in nonresponders could be due to the increase in soft palate width after surgery.

Purpose: To review the surgical results of uvulopalatopharyngoplasties (UPPP) performed at the Naval Medical Center, Portsmouth, VA, for the treatment of obstructive sleep apnea. The results will be evaluated comparing the recognized standard criteria with a proposed revised criteria., Materials and Methods: A retrospective review was completed of uvulopalatopharyngoplasties performed from January 1, 1994 to July 30, 1996. Preoperative polysomnography and apnea-related symptoms were compared with those recorded postoperatively., Results: With our new proposed criteria, an apnea-hypopnea index of less than 20 and lowest oxygen saturation of greater than 85%, the success rate of UPPP was 49%. If patients with severe sleep apnea were excluded, the success rate rose to 69%., Conclusion: UPPP alone is an effective treatment for mild to moderately severe obstructive sleep apnea. However, it is not effective as the sole treatment for severe obstructive sleep apnea.

Study Objectives: To evaluate pain, swallowing, speech, edematous response, tissue shrinkage, sleep, snoring, and safety (energy limits and adverse effects) following radiofrequency (RF) treatment to the palate in 22 subjects with sleep-disordered breathing., Design: This investigation is a prospective nonrandomized study. Polysomnography, radiographic imaging, and infrared thermography, along with questionnaires and visual analog scales, were used to evaluate the effects of RF treatment to the palate., Setting: Treatments were delivered on an outpatient basis at Stanford University Medical Center., Patients: Twenty-two healthy patients (18 men), with a mean age of 45.3+/-9.1 years, were enrolled. All were snorers seeking treatment and met predetermined criteria: a respiratory disturbance index < or = 15, oxygen saturation > or = 85%, and a complaint of daytime sleepiness., Intervention: RF was delivered to the submucosa of the palate with a custom-fabricated electrode for a mean duration of 141+/-30 s with a mean of 3.6+/-1.2 treatments per patient. Reduction of their snoring scores determined the end point of the study., Results: Neither speech nor swallowing was adversely affected. Pain was of short duration (0 to 48 h) and was controlled with acetaminophen. There were no infections. Although there was documented edema at 24 to 48 h, there were no clinical airway compromises. Polysomnographic data showed improvement in esophageal pressure measurements of the mean nadir and the 95th percentile nadir (p=0.031, p=0.001) respectively, as well as the mean sleep efficiency index (p=0.002). Radiographic imaging showed a mean shrinkage of 5.5+/-3.7 mm (p< or =0.0001). Subjective snoring scores fell by a mean of 77% (8.3+/-1.8 to 1.9+/-1.7, p=0.0001) accompanied by improved mean Epworth sleepiness scores (8.5+/-4.4 to 5.2+/-3.3, p=0.0001)., Conclusion: The results of this investigation allowed the formulation of safety parameters for RF in this defined population with mild sleep-disordered breathing. There was a documented tissue reduction and improvement in symptoms in all subjects. However, given the small sample size and short-term follow-up, these results should be confirmed by further investigation.