A CostE ectiv and Rational Surgical Approach to Patients With Snoring , Upper Airway Resistance Syndrome , or Obstructive Sleep Apnea

Laryngscope 107: June 1997 Utley et al.: Sleep Disordered Breathing The past decade has seen several innovations in the surgical techniques available for treatment of patients with sleepdisordered breathing. Outpatient techniques such as laserassisted uvulopalatoplasty (LAUP) and more aggressive procedures designed to address hypopharyngeal and base of tongue obstruc¬tion (genioglossus advancement and hyoid myotomy) have been developed and proven successful We de¬scribe the e cacy of LAUP for snoring (72.7%), upper airway resistance syndrome (81.8%), and mild (mean [*SD] respiratory disturbance index [RDI] = 12 * 8.1) obstructive sleep apnea (41.7%) in 56 patients who un¬derwent 132 LAUP procedures in a 26-month period. Thirty-two patients with more signi cant obstructive sleep apnea (mean RIM = 41.8 ± 23.1) underwent mul¬tilevel pharyngeal surgery consisting of genioglossus advancement and hyoid myotomy combined with uvulopalatopharyngoplasty. The surgical success rate in this group of patients was 85.7% when commonly accepted criteria were applied. We recommend a strati ed surgical approach to patients with sleep¬disordered breathing. Progressively worse airway ob¬struction marked by multilevel pharyngeal collapse and more severe sleep-disordered breathing is treated with incrementally more aggressive surgery addressing multiple areas of the upper airway.