Long-Term Results in Obstructive Sleep Apnea Syndrome (OSAS) after Laser-Assisted Uvulopalatoplasty (LAUP)

Abstract

Obstructive sleep apnea syndrome (OSAS) is a serious disease. The etiology of and optimum therapy options for this disorder have been much discussed and have been the subject of many publications. One much discussed therapy option is laser-assisted uvulopalatoplasty (LAUP). Despite conflicting opinions and guidelines which recommend that it should not be used, it remains in use. Patients who had previously undergone this procedure were invited for follow-up appointments, at which they were asked to complete a questionnaire, underwent an ENT examination and underwent sleep laboratory analysis using a portable sleep lab device. The average time since LAUP treatment was 11 years. The cohort comprised 25 patients. The average preoperative apnea-hypopnea-index (AHI) score was 25.25/h; the average postoperative AHI score 23.62/h. Closer examination of our data enabled us to identify 10 responders (40%) and 15 non-responders (60%). 12% (3/25) of non-responders experienced either no reduction in their AHI score or an increase compared to their preoperative AHI score of less than 5/h. In the remaining 48% (12/25), AHI increased by more than 5/h compared to the preoperative figure. Our questionnaire showed that 40% (10/25) of patients suffered from dry mouth and 20% (5/25) from foreign body sensation. The data led us to conclude that laser-assisted uvulopalatoplasty can indeed result in a reduction in AHI score comparable to other mucosal resection methods. Also in common with these methods, the efficacy of the therapy reduces with time and the procedure carries a high risk of bringing about an increase in the patient's AHI score.

<p>Laser-assisted uvulopalatoplasty (LAUP) complications and side effects: a systematic review</p>

“…The most common complications, aside from pain, were globus sensation and dryness which were reported with an incidence of about 8.2% and 7.2% of patients, respectively. In the four studies with the longest follow-up duration with a mean of 100.5 months, these two complications were reported at a rate of 12.2% and 10.8%, respectively 19,22,29,43. This suggests that these may be long-term complications as they are reported more frequently in studies that followed patients for a longer period of time.…”

Teil-Aktualisierung S3-Leitlinie Schlafbezogene Atmungsstörungen bei Erwachsenen

“…Die laserassistierte Uvulopalatoplastik (LAUP) führt in nur 50 % der Fälle zu einer Reduktion des AHI unter 10/h, in bis zu 60 % der Fälle kommt es zu postoperativen Nebenwirkungen [85]. Im Langzeitverlauf über einen Zeitraum von im Mittel 11 Jahren zeigten sich ähnliche Ergebnisse [86]. Die LAUP wird daher auch in internationalen Publikationen nicht empfohlen.…”

Overview of Surgical Therapies for Obstructive Sleep Apnea: a Concise Review Literature

“…33 Contrarily, Göktas Ö et al, found worsening AHI scores (>5/h) post LAUP in 12 out of 25 patients. 34 A recent meta-analysis and systematic review by Camacho et al, recommended clinicians either to abandon LAUP as a therapy for OSA or to perform it with caution because individual data revealed 44% of cases with worsening AHI following LAUP. 35 Camacho et al, attributed the deterioration of OSA after LAUP to the destruction of the soft palate surface which leads to the reduction of the reflexogenic dilation of the upper airway.…”

“…5 Nowadays, the usual first-line therapy for OSA is continuous positive airway pressure (CPAP). Although CPAP is still regarded as the gold-standard therapy for OSA the non-adherence rate of patients to CPAP has been documented to be as high as 34.1% (based on studies over a twenty-year time frame). 6 Consequently, CPAP non adherent patients are then managed by surgery either to increase CPAP compliance 7 or to effectively reduce the Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) to a level that alleviates the need for CPAP.…”