HEAD AND NECK Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty Murat Turhan • Asli Bostanci • Selen Bozkurt Received: 14 July 2014 / Accepted: 23 September 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract The purpose of this study was to investigate the relationship between various polysomnographic variables and the success of modified tongue base suspension com- bined with uvulopharyngopalatoplasty in patients with severe obstructive sleep apnea (OSA). A total of 90 patients who had apnea hypopnea index (AHI) [ 30 and had both oropharyngeal and hypopharyngeal obstruction were included in this prospective case series with planned data collection. All patients were assessed preoperatively and at the sixth postoperative month by polysomnography. The surgery was considered to be successful when a C50 % reduction in the mean AHI to a final AHI of \ 20/h was obtained. Multiple logistic regression analyses were performed to determine the impact of variables on the surgical success. A total of 67 patients (74.4 %) met the surgical success criteria. The univariate analysis revealed a relationship between success and AHI (P = 0.001), obstructive apnea duration (P = 0.001), sleep time with oxygen saturation below 90 % (ST 90 )(P = 0.004), mini- mum O 2 saturation (P = 0.0001), mean O 2 saturation (P = 0.011), mean O 2 desaturation (P = 0.0001), and oxygen desaturation index (P = 0.001). However, ST 90 [OR (95 % CI) = 1.40 (1.04–1.89), P = 0.023] was the only independent parameter predicting the surgical success in multivariate analysis. The ROC analysis revealed that the ST 90 value of B36 min was the best cutoff value with 96.97 % sensitivity (CI 89.5–99.6), 95.83 % specificity (CI 78.9–99.9), 98.5 % PPV (CI 91.6–100.0), and 92.0 % NPV (CI 74.0–99.0). The stratification of patients with severe OSA according to the ST 90 may allow better identification of patients in whom surgical success is probable. Keywords OSA Á Surgical success Á ST 90 Introduction Obstructive sleep apnea (OSA) is a global health problem that affects up to 20 % of adults [1]. It is a chronic disease which does not resolve spontaneously, and is rarely com- pletely cured. Continuous positive airway pressure (CPAP) is the gold standard treatment of moderate to severe OSA [2]. Unfortunately, compliance rates are poor with esti- mates that between 40 and 60 % of patients use CPAP as prescribed, many reject therapy within the first few months [3]. Surgery may be indicated to improve compliance and outcome in cases where CPAP is poorly tolerated [4]. Although anatomic disorders are eliminated by surgery, this disease cannot be eliminated fully in a significant percentage of patients, from which arises the question of whether surgical treatment is overused. If the cases in which surgical success is not probable can be accurately estimated beforehand, then unnecessary surgeries and complications can be avoided. In the current study, we aimed to determine factors predicting the success of multi- level surgery including modified tongue base suspension (mTBS) combined with uvulopharyngopalatoplasty (UPPP) in patients with severe OSA. M. Turhan Á A. Bostanci Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, Antalya, Turkey A. Bostanci (&) Dumlupinar Bul. Akdeniz University Hospital, H Blok K: 1, Konyaalti, 07070 Antalya, Turkey e-mail: draslibostanci@gmail.com S. Bozkurt Department of Biostatistics and Medical Informatics, Akdeniz University School of Medicine, Antalya, Turkey 123 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-3311-0