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(Chest. 1995;107:946-951.)
© 1995 American College of Chest Physicians

Dynamic Pharyngoscopy in Predicting Outcome of Uvulopalatopharyngoplasty for Moderate and Severe Obstructive Sleep Apnea

Loutfi S. Aboussouan MD1; Joseph A. Golish MD, FCCP1; Benjamin G. Wood MD2; Atul C. Mehta MBBS, FCCP1; David E. Wood DO2; and Dudley S. Dinner MD2

1 From the Department of Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, cleveland, Ohio.
2 From the Department of Otorhinolaryngology The Cleveland Clinic Foundation, cleveland, Ohio.

Study objective: We sought to determine whether preoperative fiberoptic pharyngoscopy (FOP) with Müller's maneuver (dynamic FOP) could be used to establish a subgroup of obstructive sleep apnea (OSA) patients with better outcome after uvulopalatopharyngoplasty (UPPP).

Design: Retrospective review of an observational cohort.

Setting: Tertiary care referral center.

Patients: Twenty-nine patients who underwent UPPP and nasopharyngeal surgery by one surgeon.

Intervention: The patients were divided into two groups based on the findings of preoperative dynamic FOP: group 1 (11 patients) had collapse of the velopharynx and the base of the tongue-epiglottis-hypopharynx (TEH) complex and group 2 (18 patients) had velopharyngeal collapse only.

Measurements and results: Surgical success was defined using a conventional definition (>50% reduction in the apnea-plus-hypopnea index [OAHI]), and a criterion for cure (>90% reduction in OAHI and postoperative OAHI<15). Both groups had a significant improvement in their OAHI. The success rate was significantly higher in patients with velopharyngeal collapse only compared with patients with additional collapse of the TEH complex (78 vs 36% with the conventional definition, and 50 vs 9% using the definition for cure, respectively). Predictive value of dynamic FOP in predicting cure failure when collapse of the TEH complex was present was 91%.

Conclusions: Dynamic FOP may help establish a subgroup of OSA patients with greater likelihood of successful UPPP. The high negative predictive value of dynamic FOP when a criterion for cure is used suggests that this maneuver could best be used to exclude patients with TEH complex collapse from UPPP.

Key Words: Müller's maneuver • pharyngoscopy • sleep apnea • uvulopalatopharyngoplasty

Submitted on April 25, 1994
Accepted on September 2, 2007






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Copyright © 1995 by the American College of Chest Physicians.