The Laryngoscope Lippincott Williams zyxwvutsrqpon & zyxwvutsrq Wilkins, Philadelphia zyxwvutsrqp 0 1999 The American Laryngological, Rhinological and Otological Society, Inc. Laser-Assisted Uvulopalatoplasty for the Treatment of Mild, Moderate, and Severe Obstructive Sleep Apnea Regina Paloyan Walker, MD; Madeleine M. Grigg-Damberger, MD; Chellam Gopalsami, PhD zyx ObjectiueslHypothesi: Until recently, laser-assisted uvulopalatoplasty (LAUP) has been used to treat only snoring and mild cases of obstructive sleep apnea zyxwvu (OSA). The purpose of this study was to evaluate the ef- ficacy and safety of LAUP in patients with mild, moder- ate, and severe OSA. Study Design: A prospective study of 38 patients who completed LAUP for the treatment of OSA who were evaluated based on the severity level of their preoperative apnea Materials and Methals: Be- tween July 1993 and December 1995,96 patients with a diagnosis of OSA based on polysomnography under- went staged outpatient LAUP treatment. --eight patients completed treatment and obtained postopera- tive polysomnography. Postoperative complications and polysomnographicfindingswere reviewed. Results: Fifteen patients had a diagnosis of mild apnea, 12 had moderate apnea, and 11 had severe apnea based on pre- operative polysomnography. The surgical response rates, defined zyxwvuts as greater zyxwvut than or equal to zyxwvu 50%0 reduction in the postoperative respiratory disturbance index (RDI) and a postoperative RDI of less than 20, were 46.7% in the mild apneics, 41.7% in the moderate apne- ics, and 45.5% in the severe apneics. Postoperativecom- plications in this series included minor bleeding, oral candidiasis, and temporary velopharyngeal insuffi- ciency. There were no serious complications. Conclu- sions: In the carefully selected and prepared patient with mild, moderate, or severe OSA, LAUP should be considered a surgical option for the treatment of this disorder. LAUP remains a cost-effective and safe alter- native to uvulopalatopharyngoplasty. Laryngoscope, 109:79-85,1999 INTRODUCTION Laser-assisted uvulopalatoplasty (LAUP) was first introduced in the United States in 1993 for the treatment of snoring. Since 1993, LAUP has become a popular treat- From the Departments of Otolaryngology-Head and Neck Surgery (R.P.w., c.G.), Loyola University-Chicago, Maywood, Illinois, and Neurol- ogy Consultants, Ltd. (M.M.G.-D.), Albuquerque, New Mexico. Editor’s Note: This Manuscript was accepted for publication August 12, 1998. Send Reprint Requests to Regina Paloyan Walker, MD, Loyola Uni- versity Medical Center, Department of Otolaryngology, 2160 South First Avenue, Maywood, IL 60153, U.S.A. ment for snoring, upper airway resistance syndrome (UARS), and mild obstructive sleep apnea (OSAL-4 The LAUP surgical response rates compare favorably with re- sults published for uvulopalatopharyngoplasty (UPPP) in patients with these disorders.5.6 The advantages often cited for LAUP include the low complication rate, the abil- ity to perform the procedure under local anesthesia, and the cost of the procedure.l+ The treatment of patients with moderate or severe OSAis often much more complex than that of patients who snore or have mild obstructive disease. At this time, nasal positive airway pressure (PAP) is the treatment of choice for moderate and severe OSA according to the Standards of Practice Committee of the American Sleep Disorders Asso- ciation (ASDA1.8 However, if the “noninvasive” treatment is unsuccessful or is rejected, surgery is a recommended op- tion for these patients. Since long-term compliance remains a major problem with nasal PAP, surgical treatment is of- ten considered by patients with moderate or severe ap- nea.Sl1Many of these patients have serious medical condi- tions, which may include alveolar hypoventilation syndrome attributable to morbid obesity, hypertension, and congestive heart failure.l2-15 Each of these conditions in- creases the morbidity of any surgical procedure requiring general anesthesia. Thus any treatment that eliminates the need for a general anesthetic, such as LAUP, should be seriously examined and used if proven safe and effective. The purpose of this study is to evaluate the role of LAUP in the treatment of mild, moderate, and severe OSA. This report examines the surgical results of 38 pa- tients with OSAS who received treatment with LAUP. The preoperative evaluations, patient selection criteria, surgi- cal technique, postoperative complications, and preopera- tive as well as postoperative polysomnographic findings are reviewed. MATERIALS zyxw AND METHODS Patient and Surgery Selection Between July 1993 and December 1995,676 consecutive pa- tients (82% men, 18% women; age range, 21-80 y) were evaluated for treatment for snoring at Loyola University Medical Center. Laryngoscope 109: January 1999 Walker et al.: Uvulopalatoplasty for Obstructive Sleep Apnea 79