Nanna Browaldh1,2, Johan Bring3, Danielle Friberg1,2. 1. Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 2. Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden. 3. Statisticon AB, Uppsala, Sweden.
Abstract
OBJECTIVE: Our previous randomized controlled trial of patients with obstructive sleep apnea syndrome (OSAS) showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration, daytime sleepiness, and quality of life in the intervention group compared to controls who had delayed surgery after 6 months. This is the continuous report with the 6- and 24-month postoperative results. STUDY DESIGN: Single-center prospective cohort study. METHODS:Sixty-five patients with apnea-hypopnea index (AHI) ≥ 15, body mass index (BMI) < 36, Epworth Sleepiness Scale (ESS) ≥ 8, and Friedman stage I or II underwent UPPP after failing nonsurgical treatment. The results from polysomnography and ESS at 6 and 24 months were compared to baseline. RESULTS: Eight percent and 20% dropped out from the 6- and 24-month follow-ups, respectively. The AHI value decreased significantly from mean (standard deviation) 52.9 (20.5) at baseline to 23.6 (20.2) after 6 months, and to 24.1 (20.9) after 24 months (P < 0.001). Patients with tonsil size 2, and 3 to 4, had significant reductions in the AHI after both follow-ups. The median ESS score decreased significantly from 13 (range 8-21) to 6.5 (1-18) after 6 months, and to 5 (2-17) after 24 months (P < 0.001). The BMI remained unchanged. There were significant modest correlations for the reductions in AHI and ESS after 24 months. CONCLUSION:Modified UPPP was effective in improving nocturnal respiration and daytime sleepiness in OSAS patients at both 6- and 24-month follow-up. Patients with tonsil size 2, and 3 to 4, benefitted similarly from surgery with improved respiration. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:1238-1244, 2018.
RCT Entities:
OBJECTIVE: Our previous randomized controlled trial of patients with obstructive sleep apnea syndrome (OSAS) showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration, daytime sleepiness, and quality of life in the intervention group compared to controls who had delayed surgery after 6 months. This is the continuous report with the 6- and 24-month postoperative results. STUDY DESIGN: Single-center prospective cohort study. METHODS: Sixty-five patients with apnea-hypopnea index (AHI) ≥ 15, body mass index (BMI) < 36, Epworth Sleepiness Scale (ESS) ≥ 8, and Friedman stage I or II underwent UPPP after failing nonsurgical treatment. The results from polysomnography and ESS at 6 and 24 months were compared to baseline. RESULTS: Eight percent and 20% dropped out from the 6- and 24-month follow-ups, respectively. The AHI value decreased significantly from mean (standard deviation) 52.9 (20.5) at baseline to 23.6 (20.2) after 6 months, and to 24.1 (20.9) after 24 months (P < 0.001). Patients with tonsil size 2, and 3 to 4, had significant reductions in the AHI after both follow-ups. The median ESS score decreased significantly from 13 (range 8-21) to 6.5 (1-18) after 6 months, and to 5 (2-17) after 24 months (P < 0.001). The BMI remained unchanged. There were significant modest correlations for the reductions in AHI and ESS after 24 months. CONCLUSION: Modified UPPP was effective in improving nocturnal respiration and daytime sleepiness in OSAS patients at both 6- and 24-month follow-up. Patients with tonsil size 2, and 3 to 4, benefitted similarly from surgery with improved respiration. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:1238-1244, 2018.
Authors: Eric J Kezirian; Michael Simmons; Richard J Schwab; Peter Cistulli; Kasey K Li; Edward M Weaver; Andrew N Goldberg; Atul Malhotra Journal: Am J Respir Crit Care Med Date: 2020-12-01 Impact factor: 21.405
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