Position Statement: Uvulopalatopharyngoplasty
Obstructive sleep apnea syndrome (OSAS) is a medical disorder with major personal and public health consequences that may fail treatment using non-invasive modalities such as positional therapy, weight loss, positive airway pressure (PAP) and mandibular advancement devices. Uvulopalatopharyngoplasty (UPPP) is a valid and generally safe treatment for OSAS in appropriately selected patients (Kezirian 2004).
Uvulopalatopharyngoplasty, first described by Fujita in 1981, remains the most common surgical procedure of the upper airway. UPPP usually reduces the Apnea Hypopnea Index (AHI), but does not usually normalize it. The AHI, however, is an imperfect, surrogate metric for OSA, and UPPP is associated with major improvements in clinical outcome. UPPP confers improved survival and reduction in risk of serious or fatal cardiovascular events in cohort and large national population studies (Weaver 2004, Lee 2018, Marti 2002). UPPP has been shown to reduce sleepiness, motor vehicle accident risk and improve overall quality of life (Joar 2017, Browaldh 2016, Browaldh 2018, Haraldsson 1995, Robinson 2009, Weaver 2011).
Upper airway surgical procedures include lateral pharyngoplasty, uvulopalatal flap, Z-palatopharyngoplasty, palatal advancement pharyngoplasty, expansion sphincter pharyngoplasty, relocation pharyngoplasty and zed-plasty. These procedures are supported by randomized trials, cohort and case series evidence for reduction of AHI and improvement in clinical criteria including blood pressure, sleepiness and quality of life (de Paula Soares 2013, Cahali 2004, Browaldh 2016, Joar 2018, Rotenberg 2014)
UPPP and its modifications have also been shown to be effective in the pediatric population, especially in handicapped populations with poor palatal control and redundant soft tissue. UPPP is listed as a potential procedure for children not responding to usual treatment in pediatric clinical practice guidelines.
UPPP and its modifications are important treatments for OSA in patients who have demonstrated an inability to consistently use continuous positive airway pressure (CPAP) therapy or other medical treatments. UPPP has been shown to be generally safe. One review of 3,572 patients showed complications incidence of 37.1 per 1000, with no fatalities while another of 3,130 found nonfatal complications of 1.5% and 30-day mortality of 0.2% (14). Uvulopalatopharyngoplasty and its variants are safe, effective therapies that result in important health and quality of life improvements in properly selected patients.
Submitted for Review 4/13/1995
Submitted for Review 3/1/1998
- Sher AE, Schechtman KB, et al. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996;19:156–77
- Fujita S, Conway W, Zorick F, Roth T, Otolaryngol Head Neck Surg. 1981 Nov-Dec; 89(6):923-34.
- Weaver EM, Woodson BT, Yueh B, Smith T, Stewart MG, et al. (2011) Studying life effects and effectiveness of palatopharyngoplasty (SLEEP) study. Subjective outcomes of isolated uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 144: 623-631.
- Weaver EM, Maynard CM, Yueh B. Survival of Veterans With Sleep Apnea: Continuous Positive Airway Pressure Versus Surgery. Otolaryngol Head Neck Surg. 2004;130:659-65.
- Lee HM, Kim HY, Suh JD, et al .Uvulopalatopharyngoplasty reduces the incidence of cardiovascular complications caused by obstructive sleep apnea: results from the national insurance service survey 2007-2014. Sleep Med. 2018 May;45:11-16. doi: 10.1016/j.sleep.2017.12.019. Epub 2018 Feb 9. PubMed PMID: 29680418.
- Marti S, Sampol G, Muñoz X, et al. Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment. Eur Respir J. 2002 Dec;20(6):1511-8.
- Joar S, Danielle F, Johan B, et al. Sleep quality after modified uvulopalatopharyngoplasty: Results from the SKUP3 randomized controlled trial. Sleep. 2017 Nov 1.
- Browaldh N, Bring J, Friberg D. SKUP(3) RCT; continuous study: Changes in sleepiness and quality of life after modified UPPP. Laryngoscope. 2016. Jun;126(6):1484-91.
- Browaldh N, Bring J, Friberg D. SKUP(3) : 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP. Laryngoscope. 2018. May;128(5):1238-1244. doi: 10.1002/lary.26835.
- Haraldsson PO, Carenfelt C, Lysdahl M, Tingvall C. Does uvulopalatopharyngoplasty inhibit automobile accidents? Laryngoscope. 1995 Jun;105(6):657-61. PubMed PMID: 7769954.
- Robinson S, Chia M, Carney AS, Chawla S, et al. Upper airway reconstructive surgery long-term quality-of-life outcomes compared with CPAP for adult obstructive sleep apnea. Otolaryngol Head Neck Surg. 2009 Aug;141(2):257-63.
- Weaver EM, Woodson BT, Yueh B, et al ; SLEEP Study Investigators. Studying Life Effects & Effectivenes of Palatopharyngoplasty (SLEEP) study: subjective outcomes of isolated uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 2011 Apr;144(4):623-31.
- Rotenberg BW, Theriault J, Gottesman S. Redefining the timing of surgery for obstructive sleep apnea in anatomically favorable patients. Laryngoscope. 2014. Sep;124 Suppl 4:S1-9. doi: 10.1002/lary.24720.
- Cahali MB, Formigoni GG, Gebrim EM, Miziara ID. Lateral pharyngoplasty versus uvulopalatopharyngoplasty: a clinical, polysomnographic and computed tomography measurement comparison. Sleep. 2004 Aug 1;27(5):942-50.
- de Paula Soares CF, Cavichio L, Cahali MB. Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea. Laryngoscope. 2014 Jan;124(1):311-6.
- Seid, AB, Martin PJ, Pransky SM, Kearns DB. Surgical therapy of obstructive sleep apnea in children with severe mental insufficiency. Laryngoscope 100:507 , 1990.
- Kosko JR, Derkay CS. Uvulopalatopharyngoplasty: treatment of obstructive sleep apnea in neurologically impaired pediatric patients. Int J Pediatr Otorhinolaryngol. 1995 Jul;32(3):241-6.
- Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, Pediatrics April 2002, VOLUME 109 / ISSUE 4
- Friedman M, Ibrahim H, Bass I (2002) Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 127: 13-21.
- Franklin KA, Haglund B, Axelsson S, Holmlund T, Rehnqvist N, Rosen M. Frequency of serious complications after surgery for snoring and sleep apnea. Acta Otoloaryngol. 2011 Mar. 131(3):298-302.
- Kezirian EJ, Weaver EM, Yueh B, Deyo RA, Khuri SF, Daley J et al. Incidence of serious complications after uvulopalatophryngoplasty. Laryngoscope. 2004 Mar. 114(3):450-3
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Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.