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Permalink Reply by Mack D Jones, MD, SAAN on September 14, 2010 at 2:16pm

I'm with you. If my doctor had told me this information from the Ohio Sleep Medicine Institute, I would have never agreed to have a UPPP. http://www.apneasupport.org/viewtopic.php?t=1435

UPPP Ohio Sleep Medicine Institue 10% success rate?
originally appeared in 2003

The Ohio Sleep Medicine Institute research suggests that traditional criteria for analyzing UPPP/LAUP response, leads to results as follows:

Responders - Patients showing significant improvement, but not "cured" or asymptomatic. 35%

Non-responders - No change or poor response. 40%

Worse after surgery 25%

By using the more sensitive RAI assessment of sleep quality or reduced fragmentation of sleep, results find:

Responders 15%

No change, poor response or worse 85%

If you had the opportunity to read the fine print to determine what "success" in the ENT surgeon's world actually means, you will find that a 50% reduction in your AHI or a reduction below 20 is defined as "success." Unfortunately, you still are left with a deadly AHI and still have to use a PAP machine. In the end, all patients, even those who had a so-called "success" have to go back to their PAP machines.

As I said in my book, their definition of "success" is my definition of "failure."

BTW, the list of complications, and adverse side effects (aside from the potential surgical complications) include severe post-op pain, food hanging up on whats left of your soft palate and liquids regurgitating back through your nose, a feeling of a lump in your throat (some describe it like a "golf ball"), difficulty swallowing, change in speech, inability to make guttural sounds (ex. some German and French sounds), more difficulty using nasal CPAP because of inability to control air going out the mouth.

It is ironic that a patient who cannot tolerate CPAP, agrees to have a UPPP with a "35-40% success rate," not knowing what that actually means and that the surgery essentially guarantees that he will have to go back to CPAP whether he/she tolerates it or not. They are back where they started and likely worse off to boot. What a great procedure!


betty mills said:

it's really so very sad for the patients that have this surgery [UPPP}, not knowing any better and truly trusting in their dr. to help them do what's best. I am one of those patients. I had the surgery in 2007 because my sleep dr. thought I was not going to ever be able to adapt to using the c-pap machine.
I trusted him and I trusted the surgeon who promised me a 90% success rate! I now have severe sleep apnea, I had mild before the surgery, i still can't seem to have much success using the c-pap machine, so I am much worse than I was before the surgery. I makes me very, very, sad!!!

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Permalink Reply by 99 on September 14, 2010 at 2:34pm

the operation was a total success but the patient died

Carl Speas said:

maybe i should

99 said:

Sue

Carl Speas said:

It cost nearly $30,000 for the surgeries I had for OSA. What a total rip off. I was robbed by my ENT. It was totally useless. He promised me a 90% sucess. My apena was only reduced by 35%. I still have 45 occurrances an hour With a 70% oxygen saturation. These proceedures should be outlawed. I am still on bpap every night.

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Permalink Reply by Glen England on September 14, 2010 at 11:31pm

I greatly appreciate your comments Dr. Park.

You are very well spoken on the subject.

Thankfully, for me, I am way better off with CPAP therapy.

My quality of life during the day has improved so may fold I cannot quantify it.

My wife says that my body and legs used to twitch and jerk through the night, and that I would often kick at her and even hurt her during the night with the wild things my body did while I was sleeping, and stopping breathing, and all.

All of this has stopped with CPAP therapy.

My body is completely at rest while I sleep now, and I wake much better. That's not to say that I enjoy getting up every morning, but, I am more awake during the day than I ever was before CPAP.

I guess you could call my case a success.

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Permalink Reply by denise exhausted on May 3, 2011 at 11:48pm

I too am worse after surgery. I have a very specific problem that several years ago surgeons tried to correct with a jaw transplant. It failedafter 9 operations and months in hospital. I am much worse off now than I ever was. A trach has been suggested and I have had one several times in my life. I hate it and feel like I would rather just go on till the end because I can't face having a Trach again. It's a morbid solution.I know CPAP will work if  I can get a mask that is custom made to fit the specific  anatomy of my face . I am slowly dieing because of this severe OSA and no one seems to be able to help me.

Mack D Jones, MD, SAAN said:

Could you expand a little more on your comment, "Then there's the entire controversy over the definition of "success?"

Steven Y. Park, MD said:

Many past meta-analyses have shown 40% success rate with the UPPP procedure. You could also argue that adeno-tonsillectomy shouldn't be done since it works in only 60% of patients. Many children will continue to have obstructive sleep apnea after having their tonsils taken out. Then there's the entire controversy over the definition of "success."

Real life compliance and tolerance for CPAP is probably less than 50%, so is CPAP not worth offering? Absolutely not. With better patient education, counseling and appropriate follow-up many more people can benefit from CPAP. Similarly, if you've exhausted all your non-surgical options and are considering surgery, you have to do it appropriately, and not just do one procedure in one part of the airway, "just to see."

If I had a choice between the patient feeling significantly better after surgery and post-op AHI in the low single digits, I choose the former. In the old days, I was too focused on getting the AHI down as low as possible. But the AHI is only one small part of the big picture. There are situations where an AHI would drop from 25 to 2 after surgery or even with CPAP, and the patient won't feel any better. For the patient, it's not considered a "success," even though from a medical standpoint, it is.

I do agree that in most cases, doing a UPPP alone won't help cure sleep apnea. However, if you have huge kissing tonsils and a small tongue with large jaws, it's likely that you'll feel much better. The challenge is in predicting who's going to respond.

Ultimately, asking if the UPPP works for obstructive sleep apnea is not a fair question, since sleep apnea is due to multiple areas of obstruction, from the tip of the nose to the tongue base. If you have three areas of clogging in a pipe, and you only unclog one area, then It's not going to work. But if the one area that you unclogged is responsible for 90% of the blockage, then opening up that one area will help greatly.

This is why addressing multiple areas simultaneously has a much higher chance of success. Various soft tissue operation have "success" rates in the 60 to 80% range. If you enlarge both upper and lower jaws (the MMA), then success rates go up to above 90%. If you bypass everything and undergo a tracheotomy, then 99%. Surgery does work, but only if performed appropriately.

In my opinion, it's pointless to talk about the value of the UPPP procedure without looking at it in conjunction with other areas, especially the tongue base. The most common reason why the UPPP doesn't work is that the tongue base wasn't addressed. Sometimes, even when both areas are addressed, you'll sometimes see persistent obstruction on one area. I remember reading one study where after UPPP and tongue base procedures were done, using pressure sensors, you could tell where persistent obstruction was happening. Dr. Tucker Woodson developed one particular procedure where the soft palate was pulled to the hard palate without cutting any more of the soft palate, and it worked pretty well.

It's bad enough that so may people go undiagnosed with obstructive sleep apnea, and even when diagnosed, are not given proper instructions and options for CPAP or oral appliance therapy. But there will always be some people who can't tolerate or benefit from CPAP or oral appliances, and will require surgery. Unfortunately, a UPPP is still being offered much too often as an isolated procedure. Patients have to know that if they're considering surgical therapy, it's a much more complex than just stiffening or trimming the soft palate.

To say that the UPPP is worthless perpetuates the misconception that surgery doesn't work. It won't work if it isn't done properly. It's never a black or white situation. I help many people benefit from CPAP or oral appliances. But of the small percentage of patients that end up going on to surgical options, the positive outcomes in my experience is what makes me continue to offer surgery.

But you can't think of surgery as the end-all either. Oftentimes, I'll offer nasal surgery to improve CPAP or oral appliance compliance. You start with basic, conservative options and work your way up to more aggressive treatment options. Different people have different needs. The challenge is finding what works for you without trying too many different options.

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Permalink Reply by Mary Z on May 4, 2011 at 1:04pm

Denise, there are now custom made masks avaiable in the US. Here is the Australian link- if you email them perhaps they can tell you where they are available in the US..  They are called TrueFit masks and are made from a mold of your face.

http://www.cpapaustralia.com.au/shopping/cpap-masks_custom-moulded-...

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