The Upper Airway Resistance Syndrome: Surgical interventions

Newman and colleagues published a prospective evaluation of surgical intervention in patients presenting over a 1-year period with snoring and EDS; only patients with Pes nadirs < —10 cm H2O and RDIs of < 5 were included. All nine patients reportedly opted for surgical interventions, including septoplasty with turbinate reduction, LAUP, UPPP, mandibular osteotomy with tongue advancement, and hyoid myotomy with suspension. The mean (± SD) pretreatment Pes nadir was —36.7 ± 16.2 cm H2O, but only two patients underwent postoperative PSG with Pes measurements. After treatment, their respective Pes nadirs had changed from — 52 to —40 cm H2O and from —30 to —17 cm H2O, which are still in ranges that are lower than the generally accepted normal range of —10 cm H2O. The authors also reported an impressive change in the mean (± SD) ESS score from 12 ± 6.6 to 3.4 ± 1.9, although three of the nine patients had initial scores within the normal range of < 7. These authors did use more appropriate and specific inclusion criteria for UARS, but they studied a small number of patients and restudied only a small proportion postoperatively. This same group of researchers later published a retrospective review of the efficacy of surgical intervention in sleep-disordered breathing. Ninety-five of 299 patients in an outpatient population referred to a surgical clinic were considered to be surgical candidates, including 11 patients with UARS who underwent LAUP. The initial evaluations showed Pes nadirs that were more negative than —20 mm Hg, along with RDIs of < 10 and ESS scores of > 7. Of the UARS patients, 81.8% reported improved EDS, with the mean (± SD) ESS score changing from 13.5 ± 4.4 to 8 ± 2.5. The authors provided a thorough description of their clinical evaluation and criteria as well as the surgical procedures, but they did not include any postoperative PSG data. Again, their patient numbers were small. Canadian Family Pharmacy

Most recently, Powell et al reported the results of palatal tissue reduction by radiofrequency ablation (somnoplasty). A 22-gauge radiofrequency needle electrode was used to apply low- to mid-level energy to the submucosa of the upper airway under local anesthesia. The 22 study subjects had snoring and mild sleep-disordered breathing. Fourteen were UARS patients, as documented by the Pes measurements. Two to three days after the procedure, the patients reported minimal pain, problems with speech and swallowing, and a mild worsening of oxyhemoglobin saturation and RDI, all of which resolved at 10 to 12 weeks. For the entire group, there was an improvement in the sleep efficiency index, the ESS score, the Pes nadir, and subjective snoring. Changes in these variables, however, were not reported for patients with UARS or in this subgroup as a whole, except for two patients with respective Pes nadirs of —19 cm H2O and —13 cm H2O, both of whom had Pes nadirs of —5 cm H2O postoperatively. Therefore, specific conclusions about the efficacy of this procedure in UARS are difficult to draw, although it does appear relatively safe. More detailed data from larger populations with UARS are needed before this procedure can be recommended as a primary therapy for this condition.

Category: Airway Resistance

Tags: arousals, continuous positive airway pressure, esophageal pressure, excessive daytime somnolence, laser-assisted uvulopalatoplasty, snoring, somnoplasty, upper airway resistance syndrome, UPPP