Am. J. Respir. Crit. Care Med., Vol 154, No. 6, 12 1996, 1759-1762.
Uvulopalatopharyngoplasty may compromise nasal CPAP therapy in sleep apnea syndrome
IL Mortimore, PA Bradley, JA Murray and NJ Douglas
Respiratory Medicine Unit, University of Edinburgh, Scotland, UK.
Uvulopalatopharyngoplasty (U3P) has been advocated for treatment of snoring
and sleep apnea/hypopnea syndrome (SAHS), but often it does not effect a
cure, so that other therapy (CPAP) is often required. We hypothesized that
patients with U3P will have increased mouth air leak during CPAP because of
loss of the soft palatal seal. This may result in decreased tolerance and
compliance if CPAP therapy is required after U3P. We have therefore
compared CPAP tolerance in 13 awake normal male subjects, 13 male patients
with SAHS and 13 male patients treated with U3P, all naive to CPAP and
matched for age and body mass index. All normal subjects and patients with
SAHS were able to tolerate pressures of at least 20 cm H2O without mouth
air leak or appreciable discomfort. In contrast male U3P patients started
to leak air via the mouth at a mean CPAP pressure of 6.8 (SD, 2.4) cm H2O
and were able to tolerate a mean maximal pressure of only 14.5 (SD, 2.6) cm
H2O, which was significantly less than that in the other two groups (p <
0.001). We also examined nasal CPAP compliance (machine run time) in eight
patients with SAHS who had previous U3P compared with 16 patients with SAHS
without U3P. Both groups were matched for age, body mass index, and
apnea/hypopnea index. Patients with U3P had significantly lower compliance
(mean, 3.5 h/night) compared with patients without U3P (mean, 5.7 h/night),
p = 0.01. We conclude that U3P may compromise nasal CPAP therapy by
increasing mouth air leak and reducing the maximal level of pressure that
can be tolerated.
