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Can obstructive sleep apnoea be a complication of uvulopalatopharyngoplasty?

Published online by Cambridge University Press:  29 June 2007

Yehuda Finkelstein ,
Yoav P. Talmi ,
Eyal Raveh ,
Jerome Orlin ,
Carlos Rudnicki ,
Menachem Fried  and
Yzhar Zahavi
Yehuda Finkelstein*
Affiliation:
Departments of Otolaryngology–Head and Neck Surgery, Meir Hospital, Kfar Saba.
Yoav P. Talmi
Affiliation:
Chaim Sheba Medical Center, Tel-Hashomert, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Eyal Raveh
Affiliation:
Beilinson Medical Center, Petah Tiqva, Tel Aviv university, Israel.
Jerome Orlin
Affiliation:
The Hematologic Service, Hasharon Hospital, Golda Medical Centre, Patah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Carlos Rudnicki
Affiliation:
Medicine C' the Cardiologic Service, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Menachem Fried
Affiliation:
Nuclear Cardiologytt, Hasharon Hospital, Golda Medical Centre, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Yzhar Zahavi
Affiliation:
Medicine C' the Cardiologic Service, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
*
Address for correspondence: Y. Finkelstein, M.D., Department of otolaryngology—Head and Neck Surgery, Meir Hospital, Kfar Saba, Israel44281. Fax: 972-9-910596
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Abstract

Polysomnography is currently used for diagnosis, evaluation and selection of therapy in patients with obstructive sleep apnoea (OSA), but clinically successful uvulopalatopharyngoplasty (UPPP) is not necessarily reflected by post-operative improvement of polysomnographic recordings. Post-operative polysomnography may suggest deterioration of pre-existing OSA or, in snorers, de-novo precipitation of OSA. Thus, if polysomnography is a reliable indicator of OSA, then OSA may be a post-operative risk of UPPP. The aims of our study were: (i) to assess the possible deleterious effect of UPPP on sleep patterns; (ii) to further define the role of cardioisotope scanning in the evaluation of OSA; (iii) to assess the reliability of polysomnography given the clinical and cardioisotope scan findings. Symptoms, polysomnography and radionuclide ventriculography were prospectively compared pre- and post-operatively in 41 patients undergoing UPPP. In 12 patients (29 per cent), there were disparate results between pre- or post-operative polysomnography and the clinical and/or radionuclide ventriculography, as follows: In four of 16 patients with abnormal pre-operative ventricular performance, there was pre-operative symptomatology of severe OSA and a bedmate's reports of apnoeic episodes. This was in contrast to normal or near normal sleep apnoea recordings. In eight patients, post-operative improvement of symptoms was reported, despite deterioration of post-operative polysomnographic recordings. In these patients the post-operative improvement of symptoms was also reflected by improved ventricular performance. Worsening of ventricular performance was not demonstrated in any patient. In conclusion, UPPP does not induce OSA. Polysomnography may underestimate or even misdiagnose cases of OSA. The diagnostic importance of patient symptomatology should be stressed particularly in those patients with only mildly abnormal or even completely normal sleep studies. A combination of polysomnographic and cardiovascular evaluation in patients with symptomatology consistent with OSA is recommended.

Keywords

Sleep apnoea syndromesSnoringPolysomnographyRadionuclide imagingUvula, surgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 3 , March 1995 , pp. 212 - 217
Copyright
Copyright © JLO (1984) Limited 1995

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