POSTOPERATIVE RISK FOLLOWING UVULOPALATOPHARYNGOPLASTY FOR OBSTRUCTIVE SLEEP-APNEA

A study was conducted to assess oxygenation and respiratory changes on the first and second postoperative nights after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). Twelve patients were postoperatively evaluated with 8-hour nocturnal polysomnography on four occasions: (1) PREOP-night before UPPP, (2) POPN1-first postoperative night, (3) POPN2-second postoperative night, and (4) 3MOS-3-month follow-up study. Results demonstrate that apnea index (Al) and respiratory disturbance index (RDI) were significantly improved at 3MOS from PREOP levels: Al (p < 0.01) and RDI (p < 0.05). There were no statistical differences from PREOP to POPN1 or POPN2 for Al, RDI, lowest oxyhemoglobin saturation (LSAT), or number of desaturations (#DESAT). One of twelve patients dropped LSAT > 10% from PREOP to POPN1 or POPN2 (82% PREOP to 71% POPN2). Patients were grouped by PREOP LSAT greater-than-or-equal-to 80% or < 80%, and the postoperative change in LSAT was evaluated by comparing PREOP to a value averaging POPN1 and POPN2. Patients with LSAT greater-than-or-equal-to 80% decreased by 2.6%; patients with LSAT < 80% improved by 6.2%. This change in LSAT between groups was statistically different (p = 0.02). These data suggest that in the majority of patients, preoperative indices remain unchanged for at least 2 days after surgery, even for patients who demonstrated improvement at 3 months. However, worsening does occur in some patients. On the basis of the results of this study and clinical experience with the postoperative course, a selective management protocol is outlined.