The Predictors in the Outcomes of the Uvulopalatopharyngoplasty in Positional and Nonpositional Obstructive Sleep Apnea Are Different

Introduction: This study aims to explore whether the variables resulting from anatomical and physiological examinations can predict the outcomes of uvulopalatopharyngoplasty in both positional and non-positional OSA. It will also investigate whether there are discrepancies between two groups.

Methods: The data of 101 patients with obstructive sleep apnea who received treatment in the department of otolaryngology at the Second Affiliated Hospital of Zhejiang University School of Medicine from 2020 to 2023 were retrospectively analyzed, Among them, 45 positional patients (POSA) and 56 non-positional patients (NPOSA), who underwent overnight polysomnography were included. The upper airway (UA) anatomy was evaluated by three-dimensional computer tomography (3D-CT). All patients received revised uvulopalatopharyngoplasty with uvula preservation and were followed using polysomnography for at least three months postoperatively.

Results: The surgical success rate in POSA undergoing UPPP is higher than NPOSA (POSA 30/45 66.7% versus NPOSA 26/56, 46.4%, p = 0.042). Logistic analysis showed that minimal lateral airway of the velopharynx (VmLAT) (OR: 0.512; 95% CI: 0.327-0.801, p = 0.03) and minimal cross-sectional airway area of velopharynx (VmCSA)(OR: 1.051; 95% CI: 1.01-1.094, p = 0.015) were significant predictors for surgical outcomes among POSA patients. In NPOSA, Age (OR: 0.905; 95% CI: 0.837-0.978, p = 0.012) and hyoid-mandibular distance (OR: 0.927; 95%CI: 0.867-0.992, p = 0.027) were significant predictors for surgical outcomes.

Conclusions: Less mLAT and more mCSA at velopharynx resulted as significant predictors of uvulopalatopharyngoplasty surgical outcomes in supine predominant OSA. Younger NPOSA patients with less hyoid-mandibular distance were more likely to achieve response after uvulopalatopharyngoplasty.