Surgical evaluation in obstructive sleep apnea: Climbing the steep part of the learning curve

摘要

The first relevant issue is how to predict outcomes of palate surgery with tonsillectomy. Higher-level evidence from cohort studies indicates that Friedman stage shows the clearest association with outcomes after uvulopalatopharyngoplasty (UPPP). There are conflicting studies about the relative value of endoscopy and the Mueller maneuver during wakefulness, but Iwanaga et al3 and Hessel and Vries4 showed that drug-induced sleep endoscopy (DISE) is also associated with UPPP outcomes. Comparison of findings from evaluation methods has not been undertaken as extensively for alternative palate procedures. This is important because some of these procedures (expansion sphincter pharyngoplasty, lateral pharyn-goplasty) have demonstrated better outcomes than UPPP in randomized trials and because only 10% of OSA cases are Friedman stage 1.