Regina P. Walker

Laser‐assisted uvulopalatoplasty for snoring and obstructive sleep apnea: Results in 170 patients

Laser‐assisted uvulopalatoplasty (LAUP) is a procedure for the treatment of snoring and, possibly, sleep apnea. Between July 1993 and December 1994, the authors prospectively evaluated 541 consecutive patients referred to their teaching hospital for possible LAUP to treat loud, disruptive snoring. Of these patients, 274 (51%) had one or more LAUP treatments. As of January 1995, LAUP treatment courses were completed in 170 patients. In this paper, the authors report preliminary results on the use of LAUP in these patients.

Uvulopalatopharyngoplasty Versus Laser-Assisted Uvulopalatoplasty for the Treatment of Obstructive Sleep Apnea†

Uvulopalatopharyngoplasty (UPPP) was the first surgical procedure specifically designed to address the palatal abnormalities seen in many patients with obstructive sleep apnea syndrome (OSAS). For adult apneic patients, UPPP remains the most commonly performed operation. Beginning in 1993, laser‐assisted uvulopalatoplasty (LAUP) was introduced for the treatment of snoring and sleep apnea. LAUP differs from UPPP because it is performed in the office using only local anesthesia, thus being very cost‐effective.

Laser‐Assisted Uvulopalatoplasty for the Treatment of Mild, Moderate, and Severe Obstructive Sleep Apnea

Objectives/Hypothesis: Until recently, laser‐assisted uvulopalatoplasty (LAUP) has been used to treat only snoring and mild cases of obstructive sleep apnea (OSA). The purpose of this study was to evaluate the efficacy and safety of LAUP in patients with mild, moderate, and severe OSA. Study Design: A prospective study of 38 patients who completed LAUP for the treatment of OSA who were evaluated based on the severity level of their preoperative apnea. Materials and Methods: Between July 1993 and December 1995, 96 patients with a diagnosis of OSA based on polysomnography underwent staged outpatient LAUP treatment. Thirty‐eight patients completed treatment and obtained postoperative polysomnography. Postoperative complications and polysomnographic findings were reviewed. Results: Fifteen patients had a diagnosis of mild apnea, 12 had moderate apnea, and 11 had severe apnea based on preoperative polysomnography. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative respiratory disturbance index (RDI) and a postoperative RDI of less than 20, were 46.7% in the mild apneics, 41.7% in the moderate apneics, and 45.5% in the severe apneics. Postoperative complications in this series included minor bleeding, oral candidiasis, and temporary velopharyngeal insufficiency. There were no serious complications. Conclusions: In the carefully selected and prepared patient with mild, moderate, or severe OSA, LAUP should be considered a surgical option for the treatment of this disorder. LAUP remains a cost‐effective and safe alternative to uvulopalatopharyngoplasty.

Identifying Obstructive Sleep Apnea in Patients Presenting for Laser‐Assisted Uvulopalatoplasty

The authors report on a series of 850 patients with snoring who were evaluated for laser‐assisted uvulopalatoplasty (LAUP). Stepwise multivariate linear regression was employed to correlate patient symptoms and characteristics to the respiratory disturbance index (RDI). Body mass index, falling asleep while driving, snoring every night, and stopping breathing during sleep were found to correlate strongly with an increasing RDI (variance of 25%). Logistic multivariate linear regression analysis was used to predict the outcome of apnea (RDI>10). This model selected all of the above variables, as well as age, male sex, and the total number of symptoms, as being strong predictors of apnea. A receiver operating characteristic curve was used to describe the ability of this model to predict apnea.

Symptoms in patients with primary hyperparathyroidism: muscle weakness or sleepiness.

OBJECTIVE To evaluate the effects of parathyroidectomy on the nonspecific symptoms associated with primary hyperparathyroidism, with an emphasis on distinguishing sleepiness from muscle weakness. METHODS We conducted a prospective cohort study of consecutive patients presenting for parathyroidectomy for the treatment of primary hyperparathyroidism. Twenty-three patients underwent assessment preoperatively and postoperatively. The Functional Outcomes of Sleep Questionnaire (FOSQ), the Epworth Sleepiness Scale (ESS), and a questionnaire of disease-specific symptoms were administered preoperatively, 2 weeks postoperatively, and 4 to 6 months postoperatively. The FOSQ assesses how sleepiness alters daytime performance, and the ESS reflects the degree of daytime sleepiness. RESULTS All 23 patients achieved normocalcemia postoperatively. Although no significant changes were found in the overall scores for the FOSQ and ESS after parathyroidectomy, there was a significant decline in the overall mean incidence of disease-specific symptoms postoperatively (P <or=0.0001 after 2 weeks and P = 0.0020 after 4 to 6 months). The five disease-specific symptoms that significantly decreased in frequency postoperatively were (1) muscle weakness, (2) polydipsia, (3) dry skin and itching, (4) memory loss, and (5) anxiety. CONCLUSION In this study, patients with primary hyperparathyroidism did not demonstrate daytime sleepiness or difficulty performing everyday activities because of sleepiness at baseline or after successful parathyroidectomy. The overall mean percentage for incidence of disease-specific symptoms, however, significantly declined postoperatively, especially in reference to muscle weakness.

Hyperparathyroidism induced by hypothyroidism

The coexistence of hyperparathyroidism and thyroid tumors and/or chronic thyroiditis has raised the possibility of an etiologic relationship. The present study was designed to test the hypothesis that the chronic elevation of thyroid‐stimulating hormone (TSH) is related to the development of hyperparathyroidism. Three groups of 24 rats each were treated for 12 weeks as follows: group 1 received propylthiouracil (PTU) in their deionized water; group 2 received PTU and thyroid hormone to suppress TSH and to serve as a control group for possible direct effects of PTU; and group 3 was not treated at all and served as another control group. At 12 weeks, 95% of group 1 rats (PTU only) showed hyperplasia of the parathyroids with a 30% mean increase in circulating parathormone.

Soft Palate Implants: A New Treatment for Obstructive Sleep Apnea?

Abstract Problem: Pillar soft palate implants are a new treatment for snoring. However, the effects of the implants in the treatment of obstructive sleep apnea (OSA) have not been studied. In this pilot study, we examined the safety and efficacy of the placement of implants in the soft palate of patients diagnosed with OSA. Methods: Adult patients with a diagnosis of mild to moderate obstructive sleep apnea were chosen to participate in this multi-center, nonrandomized, prospective, clinical study. Patients with other mitigating procedures or previous surgical treatments of the soft palate or upper airway and significant nasal and/or tongue obstruction were excluded. All patients will have an attended, in-laboratory polysomnogram prior to and 6 months following the implant procedure. Results: At this time, a total of 4 patients have been enrolled in this study. To date, there have been no adverse events. Our preliminary results demonstrate a clinical improvement in symptoms associated with OSA. Polysomnographic data are forthcoming. Conclusion: Our initial impression is that palatal implants can be safely placed in patients with mild to moderate obstructive sleep apnea. Also, a clinical improvement has been noted in the symptoms associated with OSA. Significance: Palatal implants may be a new treatment for the treatment of obstructive sleep apnea. Support: None reported.

10:40 AM: One-Year Follow-up of Palatal Implants for OSA Treatment

randomized to receive treatment either with palatal implant or with a sham procedure. At three months, the subjects were reassessment and polysomnography were repeated. Subjective and objective results were then compared for the experimental and control groups. RESULTS: 57 patients completed the study (27 experimental and 30 control). Snoring reduction by 50% in the experimental group was significantly higher than in the sham group (72% vs. 0%). Improvement in snoring was inversely related to FTP (I, II, III) in the experimental group. Change in ESS was not significant between the two groups. However, AHI decrease was significantly greater in the experimental group versus the controls. QOL scores were improved in the experimental group as compared with the control group. CONCLUSIONS: This study presents Level I evidence on the effectiveness of palatal implant in elimination of snoring and reduction of AHI.

Sleep disorders committee: Thinking about opening your own sleep lab?

Abstract Otolaryngologists are increasingly involved in the diagnosis and treatment of snoring and sleep apnea. Sleep studies are an essential part of treating this substantial population of patients. Sleep studies can be performed at home, in a hospital, or in a freestanding sleep laboratory. Most of these laboratories are owned or managed by neurologists or pulmonologists who specialize in sleep medicine. Otolaryngologists are currently dependent on these labs and their interpreting physicians to obtain the data necessary to advise and treat their patients. Are otolaryngologists sleeping on the job? Should we open our own sleep laboratories or perform home studies? Performing sleep studies and dispensing CPAP devices is comparable to ordering an audiogram and dispensing hearing aids. Otolaryngologists own the equipment needed to perform an audiogram, hire audiologists to work in their office, interpret the audiogram, and then recommend and provide surgical and/or medical treatment. Can and should we do the same for sleep patients? The purpose of this seminar is to explore the pros and cons of opening your own sleep lab. The debate over home sleep studies versus in laboratory attended studies will be discussed. The practical experience of one of our colleagues on how to go from the idea to the reality of owning and running a sleep lab will be presented. Performing CPAP titration studies and dispensing CPAP will be addressed. Business and legal issues will be reviewed as well.

27 Laser-Assisted Uvulopalatoplasty for Obstructive Sleep Apnea: A Review of Treatment Failures

In a series of 541 patients who were evaluated for laserassisted uvulopalatoplasty (LAUP) for snoring, 170 patients have completed LAUP treatment. Among the 170 patients, 65 had obstructive sleep apnea syndrome based on preoperative polysomnography. Thirty-three patients (51%) has postoperative polysomnograms available for comparison. Surgical success with postoperative respiratory disturbance index (RDI) was achieved in 16 (48%) patients. Unfortunately, seven (21%) had postoperative RDI that was worse than preoperative RDI. The focus of this report is to determine if there are preoperative factors that could predict who will fail LAUP treatment of obstructive sleep apuea syndrome. Polysomnographic data, as well as history and physical examination, will be reviewed.