JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY) ›› 2017, Vol. 31 ›› Issue (1): 55-63.doi: 10.6040/j.issn.1673-3770.0.2017.047

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Meta-analysis of the uvulopalatopharyngoplasty(UPPP)and modified UPPP for obstructive sleep apnea hypopnea syndrome.

  

  1. Department of Otorhinolaryngology, 1. Affiliated Jiangning Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu, China;2. Department of Otolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu, China
  • Received:2017-02-07 Online:2017-02-16 Published:2017-02-16

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Abstract: Objective To assess the efficacy of various soft palate surgeries for obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Clinical studies of the soft palate surgical procedures for OSAHS were searched in databases including Cochrane, MEDLINE and PubMed, from their inception to October, 2015. References of the selected studies then underwent retrospective review and citation retrieval. Two reviewers independently screened the articles according to the predefined inclusive and exclusive criteria, and then extracted necessary data and evaluated quality of the included studies. A meta-analysis was performed using RevMan 5.1.0. Results A total of 20 self-controlled trials or RCTs involving 631 patients(88% males)were finally included. Quality evaluation was conducted independently by the two reviewers and crosschecked. Polysomnograph was adopted as a diagnostic criterion, but subjective assessment was used often for the evaluations of obstructive sites. Meta-analyses showed a significant improvement in apnea hyponea index(AHI), lowest saturation(LSAT)and Epworth sleepiness scale score(ESS). Sensitivity analysis indicated that these results were stable. Conclusion High-quality studies as well as objective indicators for the evaluation of obstructive sties are still needed. The soft palate surgeries are effective in reducing AHI and ESS, and enhancing LSAT. To date, no evidence has suggested one surgical approach is more effective than the others.

Key words: Modified uvulopalatopharyngoplasty, Soft palate, Meta-analysis, Sleep apnea, obstructive, Uvulopalatopharyngoplasty, Snoring

CLC Number: 

  • R766.7
[1] Fujita S, Conway W, Zorick F, et al. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 1981, 89(6):923-934.
[2] Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome[J]. Laryngoscope, 2003, 113(11):1961-1968.
[3] Friedman M, Ibrahim HZ, Vidyasagar R, et al. Z-palatoplasty(ZPP): a technique for patients without tonsils[J]. Otolaryngol Head Neck Surg, 2004, 131(1):89-100.
[4] 付忠良, 张峰, 何岩, 等. 切除部分腭咽肌的改良UPPP术后疗效观察[J]. 临床耳鼻咽喉头颈外科杂志,2013, 27(12):621-625. FU Zhongliang, ZHANG Feng, HE Yan, et al. The clinical investigation of the potential complications of H-UPPP surgery in removing the partial pharyngeal muscle[J]. Clin J Otorhinolarynol Head Neck Surg, 2013, 27(12):621-625.
[5] Lee LA, Yu JF, Lo YL, et al. Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial[J]. PLoS One, 2014, 9(5):e97186.
[6] Johnson JT, Vates J, Wagner RL. Reduction of snoring with a plasma-mediated radiofrequency-based ablation(Coblation)device[J]. Ear Nose Throat J, 2008, 87(1):40-43.
[7] Yang D, Zhou HF, Xie Y. Efficacy of uvulopalatopharyngoplasty combined with oral appliance in treatment of obstructive sleep apnea-hypopnea syndrome[J]. Ir J Med Sci, 2015, 184(2):329-334.
[8] Wilhelmsson B, Tegelberg A, Walker-Engstrom ML, et al. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea[J]. Acta Otolaryngol, 1999, 119(4):503-509.
[9] Liu SR, Yi HL, Yin SK, et al. Associated predictors of therapeutic response to uvulopharyngopalatoplasty for severe obstructive sleep apnea hypopnea syndrome[J]. Eur Arch Otorhinolaryngol, 2013, 270(4):1411-1417.
[10] Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions[M]. Wiley-Blackwell, 2008.
[11] Yang D, Zhou HF, Xie Y. Efficacy of uvulopalatopharyngoplasty combined with oral appliance in treatment of obstructive sleep apnea-hypopnea syndrome[J]. Ir J Med Sci, 2015, 184(2):329-334.
[12] Browaldh N, Nerfeldt P, Lysdahl M, et al. SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea[J]. Thorax, 2013, 68(9):846-853.
[13] Shin SH, Ye MK, Kim CG. Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae[J]. Otolaryngol Head Neck Surg, 2009, 140(6):924-929.
[14] Walker-Engstrom ML, Tegelberg A, Wilhelmsson B, et al. 4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized study[J]. Chest, 2002, 121(3):739-746.
[15] Myatt HM, Croft CB, Kotecha BT, et al. A three-centre prospective pilot study to elucidate the effect of uvulopalatopharyngoplasty on patients with mild obstructive sleep apnoea due to velopharyngeal obstruction[J]. Clin Otolaryngol Allied Sci, 1999, 24(2):95-103.
[16] Woodson BT, Robinson S, Lim HJ. Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 2005, 133(2):211-217.
[17] Yang HB, Wang Y, Dong MM. Effect of Han-uvulopalatopharyngoplasty on flow-mediated dilatation in patients with moderate or severe obstructive sleep apnea syndrome[J]. Acta Otolaryngol, 2012, 132(7):769-772.
[18] Han D, Ye J, Lin Z, et al. Revised uvulopalatopharyngoplasty with uvula preservation and its clinical study[J]. ORL J Otorhinolaryngol Relat Spec, 2005, 67(4):213-219.
[19] Yu S, Liu F, Wang Q, et al. Effect of revised UPPP surgery on ambulatory BP in sleep apnea patients with hypertension and oropharyngeal obstruction[J]. Clin Exp Hypertens, 2010, 32(1):49-53.
[20] Kim MJ, Kim BY, Lee DC, et al. A modified uvulopalatal flap with lateral pharyngoplasty for treatment in 92 adults with obstructive sleep apnoea syndrome[J]. Clin Otolaryngol, 2013, 38(5):415-419.
[21] Ferguson KA, Heighway K, Ruby RR. A randomized trial of laser-assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea[J]. Am J Respir Crit Care Med, 2003, 167(1):15-19.
[22] Kern RC, Kutler DI, Reid KJ, et al. Laser-assisted uvulopalatoplasty and tonsillectomy for the management of obstructive sleep apnea syndrome[J]. Laryngoscope, 2003, 113(7):1175-1181.
[23] Mickelson SA. Laser-assisted uvulopalatoplasty for obstructive sleep apnea[J]. Laryngoscope, 1996, 106(1 Pt 1):10-13.
[24] Neruntarat C. Long-term results of palatal implants for obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2011, 268(7):1077-1080.
[25] Maurer JT, Sommer JU, Hein G, et al. Palatal implants in the treatment of obstructive sleep apnea: a randomised, placebo-controlled single-centre trial[J]. Eur Arch Otorhinolaryngol, 2012, 269(7):1851-1856.
[26] Walker RP, Levine HL, Hopp ML, et al. Extended follow-up of palatal implants for OSA treatment[J]. Otolaryngol Head Neck Surg, 2007, 137(5):822-827.
[27] Nordgard S, Hein G, Stene BK, et al. One-year results: palatal implants for the treatment of obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2007, 136(5):818-822.
[28] Neruntarat C, Chantapant S. Palatal Suspension and Uvulopalatopharyngoplasty for Obstructive Sleep Apnea[J]. International Medical Journal, 2010, 17(3):213-217.
[29] Yi HL, Yin SK, Zhang YJ, et al. Z-palatopharyngoplasty for obstructive sleep apnea/hypopnea syndrome[J]. Otolaryngol Head Neck Surg, 2009, 140(5):640-645.
[30] Woodson BT, Robinson S, Lim HJ. Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 2005, 133(2):211-217.
[31] Howick J, Chalmers I, Glasziou P, et al. Oxford centre for evidence-based medicine. Explanation of the 2011 Oxford Centre for Evidence-Based Medicine(OCEBM)Levels of Evidence(Background Document), 2011[2013-07-12]. http://www. cebm. net/index. aspx, 2011.
[32] Vilaseca I, Morello A, Montserrat JM, et al. Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea[J]. Arch Otolaryngol Head Neck Surg, 2002, 128(4):435-440.
[33] Maisel RH, Antonelli PJ, Iber C, et al. Uvulopalatopharyngoplasty for obstructive sleep apnea: a community's experience[J]. Laryngoscope, 1992,(6):604-607.
[34] Lin HC, Friedman M, Chang HW, et al. Z-palatopharyngoplasty plus radiofrequency tongue base reduction for moderate/severe obstructive sleep apnea/hypopnea syndrome[J]. Acta Otolaryngol, 2010, 130(9):1070-1076.
[35] Osman EZ, Osborne JE, Hill PD, et al. Uvulopalatopharyngoplasty versus laser assisted uvulopalatoplasty for the treatment of snoring: an objective randomised clinical trial[J]. Clin Otolaryngol Allied Sci, 2000, 25(4):305-310.
[36] Hofmann T, Schwantzer G, Reckenzaun E, et al. Radiofrequency tissue volume reduction of the soft palate and UPPP in the treatment of snoring[J]. Eur Arch Otorhinolaryngol, 2006, 263(2):164-170.
[37] Weaver EM, Woodson BT, Yueh B, et al. Studying Life Effects & Effectiveness of Palatopharyngoplasty(SLEEP)study: subjective outcomes of isolated uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 2011, 144(4):623-631.
[38] Belloso A, Morar P, Tahery J, et al. Randomized-controlled study comparing post-operative pain between coblation palatoplasty and laser palatoplasty[J]. Clin Otolaryngol, 2006, 31(2):138-143.
[39] Suzuki M, Saigusa H, Kurogi R, et al. Postoperative monitoring of esophageal pressure in patients with obstructive sleep apnea-hypopnea syndrome who have undergone tonsillectomy with uvulopalatopharyngoplasty[J]. Ann Otol Rhinol Laryngol, 2008, 117(11):849-853.
[40] Vilaseca I, Morello A, Montserrat JM, et al. Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea[J]. Arch Otolaryngol Head Neck Surg, 2002, 128(4):435-440.
[41] Elbassiouny AM. Soft palatal webbing flap palatopharyngoplasty for both soft palatal and oropharyngeal lateral wall collapse in the treatment of snoring and obstructive sleep apnea: a new innovative technique without tonsillectomy[J]. Sleep Breath, 2015, 19(2):481-487.
[42] Lin HC, Friedman M, Chang HW, et al. Z-palatopharyngoplasty plus radiofrequency tongue base reduction for moderate/severe obstructive sleep apnea/hypopnea syndrome[J]. Acta Otolaryngol, 2010, 130(9):1070-1076.
[43] Lysdahl M, Haraldsson PO. Uvulopalatopharyngoplasty versus laser uvulopalatoplasty: prospective long-term follow-up of self-reported symptoms[J]. Acta Otolaryngol, 2002, 122(7):752-757.
[44] De Kermadec H, Blumen MB, Engalenc D, et al. Radiofrequency of the soft palate for sleep-disordered breathing: a 6-year follow-up study[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2014, 131(1):27-31.
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