| 1. |
- Browaldh, Nanna, et al.
(författare)
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15-year efficacy of uvulopalatopharyngoplasty based on objective and subjective data
- 2011
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Ingår i: Acta Oto-Laryngologica. - : Informa Healthcare. - 0001-6489 .- 1651-2251. ; 131:12, s. 1303-1310
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Tidskriftsartikel (refereegranskat)abstract
- Conclusions: This follow-up showed a stable and significant decrease in median oxygen desaturation index 4% (ODI(4)) values over the years. Approximately two-thirds of the patients fulfilled the success criteria (ODI4 reduction of 50% and andlt;20) after 15 years. A majority had improved/cured excessive daytime sleepiness (EDS) and were satisfied. No increased mortality rate was seen. Objectives: To evaluate sleep apnoea recordings and symptoms in patients with obstructive sleep apnoea syndrome 15 years after uvulopalatopharyngoplasty (UPPP) compared to baseline and previous follow-ups. Methods: This was a non-randomized, prospective intervention study on 50 patients who underwent UPPP during 1985-88. Their initial median age was 49 years (range 38-71) and ODI4 was 26.5 (4-82). Results: In all, 13 patients had died; 26 patients underwent sleep apnoea recordings. Median ODI4 had decreased from 26.5 (range 4-82) to 8.5 (0-60), p andlt; 0.01, a mean reduction of 52%; 65% of patients achieved the success criteria. One-third was objectively categorized as non-snorers. Median body mass index was unchanged. The questionnaires were answered by 32 of 37 patients; 88% reported improved or cured EDS and 78% were satisfied. Pharyngeal disturbances ratings were low. The standardized mortality rate did not differ from the general Swedish population.
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| 2. |
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| 3. |
- Browaldh, Nanna, et al.
(författare)
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SKUP3 randomised controlled trial : polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea
- 2013
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 68:9, s. 846-853
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the 6-month efficacy of uvulopalatopharyngoplasty (UPPP) compared with expectancy in selected patients with obstructive sleep apnoea syndrome (OSAS).DESIGN: A prospective single-centre randomised controlled trial with two parallel arms stratified by Friedman stage and body mass index (BMI).PARTICIPANTS: 65 consecutive patients with moderate to severe OSAS (apnoea-hypopnoea index (AHI) ≥15 events/h sleep), BMI <36 kg/m(2), Epworth sleepiness scale ≥8, Friedman stage I or II.INTERVENTION: Surgical treatment with UPPP. The control group underwent UPPP after a delay of 6 months.OUTCOMES: Changes in AHI and other polysomnography parameters at baseline compared with the 6-month follow-up.RESULTS: All patients (32 in the intervention group and 33 in the control group) completed the trial. The mean (SD) AHI in the intervention group decreased significantly (p<0.001) by 60% from 53.3 (19.7) events/h to 21.1 (16.7) events/h . In the control group the mean AHI decreased by 11% from 52.6 (21.7) events/h to 46.8 (22.8) events/h, with a significant difference between the groups (p<0.001). The mean time in the supine position and the BMI were unchanged in both groups. Subgroup analyses for Friedman stage, BMI group and tonsil size all showed significant reductions in AHI in the intervention group compared with controls. There were no severe complications after surgery.CONCLUSIONS: This trial demonstrates the efficacy of UPPP in treating selected patients with OSAS with a mean reduction in AHI of 60% compared with 11% in controls, a highly significant and clinically relevant difference between the groups.TRIAL REGISTRATION NUMBER: NCT01659671.
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| 4. |
- Browaldh, Nanna
(författare)
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Upper airway surgery in obstructive sleep apnoea : descriptive, observational and randomised controlled studies
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obstructive sleep apnoea syndrome (OSAS) is a general health problem which causes daytime sleepiness, impaired quality of life and increased morbidity and mortality. A narrow upper airway anatomy is a common cause of OSAS, and tracheostomy was the initial surgical treatment for OSAS. During the 1980s and 1990s uvulopalatopharyngoplasty (UPPP) was the predominant treatment before continuous positive airway pressure (CPAP) and mandibular retaining devices (MRDs) became available in Sweden. The degree of evidence for the efficacy of surgical treatments, especially UPPP, has been very low so far. The results have also varied, depending on the selection of patients and the surgical method. Therefore, randomised controlled trials (RCTs) and long-term follow-up studies in this field have been called for. This thesis evaluates the long-term findings after UPPP in unselected patients, as well as tracheostomy and UPPP (modified, conservative technique) as treatments in selected OSAS patients who have failed other nonsurgical treatments and therefore risk remaining untreated. In Paper 1, a retrospective cohort study of 10 severe and obese OSAS patients, the tolerability of custom-made tracheostomy tubes, nocturnal respiration and excessive daytime sleepiness (EDS) symptoms were evaluated. Eigth tolerated the tube for more than 6 months. The oxygen desaturation index (ODI4) decreased from 81 (range 55–126) to 13 (1–87) and EDS measured with the Epworth Sleepiness Scale (ESS) was reduced from a median of 18 (8–23) to 5 (0–7). Tracheostomy served as a link to other OSAS treatments. Paper 2 was a 15-year follow-up of 50 OSAS patients after UPPP. In all, 13 patients had died; 26 patients underwent polygraphy recordings. The median ODI4 had decreased from 26.5 (range 4–82) to 8.5 (0–60) (p < 0.01), a mean reduction of 52%. Sixty-five per cent of patients satisfied the success criteria. One third were objectively categorised as non-snorers. The median BMI was unchanged. The questionnaires were answered by 32 of 37 patients; 88% reported improved or cured EDS and 78% were satisfied. The median ESS score 15 years after UPPP surgery was 6 (0–19). Pharyngeal disturbance ratings were low. The standardised mortality rate did not differ from that of the general Swedish population. Paper 3 was a prospective RCT called Sleep apnoea Karolinska UPPP (SKUP3), with two parallel arms and stratification by Friedman stage and BMI. Sixty-five consecutively included patients with moderate to severe OSAS, BMI < 36 kg/m2, ESS ≥ 8, Friedman stage I or II. Sixty-five patients were randomised to intervention (UPPP) or control (expectancy and UPPP after a delay of six months). The mean AHI measured by polysomnography in the intervention group had significantly decreased by 60%, from 53.3 (sd 19.7) to 21.1 (16.7). In the control group, the mean AHI decreased by 11%, from 52.6 (21.7) to 46.8 (22.8), a significant difference between the groups. The mean time in the supine position and BMI were unchanged in both groups. Subgroup analyses of Friedman stage, BMI group and tonsil size all showed significant reductions of AHI in the intervention group, compared to controls. There were no severe complications after surgery. In Paper 4 the same SKUP3 subjects were evaluated concerning changes in the ESS and the quality of life, as well as in vigilance tests. The mean ESS in the intervention group decreased significantly from 12.5 (sd 3.2) to 6.8 (3.9), but there was a non-significant change in the control group. Significant differences between groups in favour of UPPP involved changes in the ESS, several SF-36 domains (general health, vitality and social functioning), as well as in sleep latency. Changes in the ESS correlated significantly with changes in vitality, social functioning and sleep latency, as well as with changes in the AHI, nadir O2 and the arousal index. In summary, tracheostomy may constitute an alternative treatment in obese patients with severe OSAS. The improvements in nocturnal respiration and daytime sleepiness after UPPP appeared to remain stable after 15 years. UPPP may also have a protective role against mortality. The SKUP3 showed that modified UPPP significantly improved respiratory parameters, daytime sleepiness and the quality of life, compared to controls. Since upper airway surgery appears to be effective and safe, it should be offered to selected OSAS patients.
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| 5. |
- Fehrm, Johan, et al.
(författare)
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Blood pressure after modified uvulopalatopharyngoplasty : results from the SKUP3 randomized controlled trial.
- 2017
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Ingår i: Sleep medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 34, s. 156-161
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveObstructive sleep apnea (OSA) is a risk factor for hypertension. The SKUP3 study showed that modified uvulopalatopharyngoplasty (UPPP) significantly improved nocturnal respiration, sleepiness, and quality of life. The aim of this study was to evaluate the impact of surgery on blood pressure in patients with OSA.MethodsWe used a single-center randomized controlled trial to compare modified UPPP with controls at baseline and after six months. The controls received delayed surgery with an additional six-month follow-up. All operated patients also had a follow-up after 24 months. Polysomnography was performed at each follow-up, with systolic and diastolic blood pressure (SBP, DBP) measured the morning after.ResultsA total of 65 patients were randomized to intervention (n = 32) or control (n = 33). At follow-up (n = 61/65, 94%), there were significant differences between the groups in both mean SBP (−9.4 mmHg [95% CI: −17.9, −0.83], p < 0.05) and mean DBP (−6.4 mmHg [95% CI: −12.8, −0.04], p < 0.05), in favor of UPPP. Blood pressure and respiratory parameters at follow-up correlated. The analyses of all operated patients showed a significant decrease in mean (SD) blood pressure after six months (n = 49/65, 75%; SBP: −4.5 [9.0], p = 0.001; DBP: −2.2 [6.6], p = 0.030) as well as after 24 months (n = 35/65, 54%; SBP: −8.9 [11.5], p < 0.0001; DBP: −4.2 [9.4], p = 0.012).ConclusionsBlood pressure was significantly decreased after surgery, indicating that modified UPPP decreases the blood pressure, in a selected group of patients with moderate to severe OSA. The long-term effect was also significant, but these results are uncertain due to a high proportion of missing values.
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| 6. |
- Fehrm, Johan, et al.
(författare)
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Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea : A Randomized Clinical Trial
- 2020
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Ingår i: JAMA Otolaryngology - Head and Neck Surgery. - : American Medical Association (AMA). - 2168-6181 .- 2168-619X. ; 146:7, s. 647-654
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Adenotonsillectomy (ATE) is one of the most common surgical procedures to treat children with obstructive sleep apnea (OSA), but to our knowledge there are no randomized clinical trials confirming the benefit of surgery compared with watchful waiting in children between 2 and 4 years of age.Objective: To determine whether ATE is more effective than watchful waiting for treating otherwise healthy children with mild to moderate OSA.Design, Setting, and Participants: This randomized clinical trial was conducted from December 2014 to December 2017 at the Otorhinolaryngology Department of the Karolinska University Hospital, Stockholm, Sweden. A total of 60 children, 2 to 4 years of age, with an obstructive apnea-hypopnea index (OAHI) score of 2 or greater and less than 10, were randomized to ATE (n = 29) or watchful waiting (n = 31). A total of 53 participants (88%; ATE, n = 25; watchful waiting, n = 28) completed the study. Data were analyzed from August 2018 to December 2018.Interventions: Adenotonsillectomy.Main Outcomes and Measures: The primary outcome was the difference between the groups in mean OAHI score change. Secondary outcomes were other polysomnography parameters, score on the Obstructive Sleep Apnea-18 (OSA-18) questionnaire, and subgroup analyses. Polysomnography and the OSA-18 questionnaire were completed at baseline and after 6 months.Results: Of the 60 included children, 34 (57%) were boys and the mean (SD) age at first polysomnography was 38 (9) months. Both groups had a decrease in mean OAHI score, and the difference in mean OAHI score change between the groups was small (-1.0; 95% CI, -2.4 to 0.5), in favor of ATE. However, there were large differences between the groups in favor of ATE regarding the OSA-18 questionnaire (eg, total OSA-18 score: -17; 95% CI, -24 to -10). Also, a subgroup analysis of 24 children with moderate OSA (OAHI ≥5 and <10) showed a meaningful difference in mean OAHI score change between the groups in favor of ATE (-3.1; 95% CI, -5.7 to -0.5). Of 28 children, 10 (36%) in the watchful waiting group received ATE after the follow-up, and 7 of these had moderate OSA at baseline.Conclusions and Relevance: This randomized clinical trial found only small differences between the groups regarding changes in OAHI, but further studies are needed. However, there were large improvements in quality of life after ATE. These results suggest that otherwise healthy children with mild OSA and mild effect on quality of life may benefit from watchful waiting, while children with moderate OSA should be considered for ATE.Trial Registration: ClinicalTrials.gov Identifier: NCT02315911.
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| 7. |
- Friberg, Danielle, et al.
(författare)
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Long-term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty
- 2020
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Ingår i: The Laryngoscope. - : Wiley. - 0023-852X .- 1531-4995. ; 130:1, s. 263-268
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES/HYPOTHESIS: We have previously shown that modified uvulopalatopharyngoplasty (UPPP) is effective to treat obstructive sleep apnea (OSA) and that the effect is stable after 24 months. This continuous report includes questionnaires and phone interviews.STUDY DESIGN: Prospective intervention study.METHODS: Sixty-five patients with apnea-hypopnea index (AHI) score ≥ 15, body mass index <36 kg/m2 , and Epworth Sleepiness Scale (ESS) score ≥ 8 underwent modified UPPP after failing nonsurgical treatment. The results from a patient questionnaire at 6 and 24 months after surgery were correlated with age, body mass index, and ESS and AHI scores. Patients reporting side effects and/or regretting the surgery after 24 months were selected for phone interviews 9 years after surgery.RESULTS: The response rate was 80% and 74% at the 6- and 24-month follow-ups, respectively. Of those who responded to the questionnaire, 96% and 83% were satisfied after 6 and 24 months, respectively; 98% and 92% recommended the surgery. Side effects (globus, mucus, and voice and swallowing disorders) occurred in 38% and 31%, respectively. Dissatisfaction correlated significantly with high postoperative AHI and ESS scores, but not with occurrence of side effects. Younger subjects had a higher rate of recommendation and lower rate of side effects than did older subjects. Phone interviews after 9 years were responded to by 14 of 16 selected patients, and the responders reported minor or no side effects.CONCLUSIONS: The vast majority of the OSA patients were satisfied 24 months after surgery, even though a third of them were experiencing side effects. Younger patients had fewer side effects than did older patients. Patients with better OSA outcomes were also more satisfied. After 9 years the side effects were no longer problematic.LEVEL OF EVIDENCE: 2b Laryngoscope, 2019.
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| 8. |
- Sundman, Joar, et al.
(författare)
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Effectiveness of Tonsillectomy vs Modified Uvulopalatopharyngoplasty in Patients With Tonsillar Hypertrophy and Obstructive Sleep Apnea The TEAMUP Randomized Clinical Trial
- 2022
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Ingår i: JAMA Otolaryngology - Head and Neck Surgery. - : American Medical Association (AMA). - 2168-6181 .- 2168-619X. ; 148:12, s. 1173-1181
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Tidskriftsartikel (refereegranskat)abstract
- Importance Modified uvulopalatopharyngoplasty (mUPPP) is a surgical treatment for selected adults with obstructive sleep apnea (OSA). Tonsillectomy (TE) alone is a less extensive alternative treatment. Objective To investigate whether mUPPP is more effective than TE alone in treating adult patients with tonsillar hypertrophy and moderate to severe OSA. Design, Setting, and Participants This blinded randomized clinical trial compared the effectiveness of mUPPP with TE alone before surgery and 6 months postsurgery in adults with tonsillar hypertrophy (sizes 2, 3, or 4 according to the Friedman staging) and moderate to severe OSA in a university hospital in Stockholm, Sweden. Participants underwent surgery from January 2016 to February 2021; the last postsurgery follow-up was completed in September 2021. Data analyses were performed from January to September 2022. Interventions mUPPP vs TE alone. Main Outcomes and Measures Between-group differences on the apnea-hypopnea index (AHI) and Epworth sleepiness scale (ESS). Results The study cohort comprised 93 patients (mean [SD] age, 41.6 [9.4] years; 80 [86%] men; race/ethnicity were not considered) with a mean (SD) body mass index of 29.0 (2.8), calculated as weight in kg divided by height in m(2). Of these, 90 participants (97%) completed the protocol (mUPPP, n = 45; TE, n = 45). The mean (SD) AHI score (number of events per hour [events/h]) for the mUPPP group decreased by 43%, from 51.0 (22.6) to 28.0 (20.0) events/h; and for the TE group, 56%, from 56.9 (25.1) to 24.7 (22.6) events/h. The mean between-group difference in AHI score was 9.2 events/h (95% CI, 0.5 to 17.9), with a small effect size (Cohen d = 0.44) in favor of TE. For ESS scores, the between-group difference was also small, only 1.1 (95% CI, -1.3 to 3.4; Cohen d = 0.21). Neither difference was considered to be clinically relevant. Conclusions and Relevance This randomized clinical trial demonstrated that mUPPP was not more effective than TE alone in treating patients with tonsillar hypertrophy and moderate to severe OSA. However, there was a small difference in favor of TE. Because TE alone is less extensive, it could be considered as an alternative to mUPPP in this selected group of patients with OSA.
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| 9. |
- Sundman, Joar, et al.
(författare)
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Eight-Year Follow-up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea
- 2021
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Ingår i: The Laryngoscope. - : John Wiley & Sons. - 0023-852X .- 1531-4995. ; 131:1, s. E307-E313
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate whether modified uvulopalatopharyngoplasty (UPPP) for treatment of obstructive sleep apnea (OSA) remained effective after 8 years. Methods Prospective intervention study. Sixty-five patients with OSA were offered re-evaluation with polysomnography and the Epworth Sleepiness Scale (ESS) 8 years after UPPP. Results were compared with baseline and with a previous 2-year follow-up. Baseline predictors were analyzed with regression analyses. Results The dropout rate at the 8-year follow-up was 28%. The mean decrease in apnea-hypopnea index (AHI) between baseline and the 8-year follow-up was significant, 14.0 events/hour (from 52.9 to 38.9), 27% (P < .001). The mean increase in AHI between the 2-year and the 8-year follow-up was significant, 14.7 events/hour (from 24.2 to 38.9), 61% (P < .0001). Overweight at baseline predicted an AHI at the 8-year follow-up that was 22.9 events higher compared to patients with normal weight (P= .015). An increase in body mass index (BMI) of 1 kg/m(2)between baseline and the 8-year follow-up predicted a mean AHI increase of 3.8 events/hour (P= .015). The median decrease in ESS between baseline and the 8-year follow-up was significant, 7 (from 13.0 to 6.0), 54% (P < .0001). The median increase in ESS between the 2-year and the 8-year follow-up was not significant, 1.0 (from 5.0 to 6.0), 20%. Conclusion Modified UPPP was effective as a long-term treatment for OSA in selected patients, although the effect on AHI decreased over time. Daytime sleepiness remained improved even in the long term. High BMI at baseline and an increase in BMI predicted a reduced long-term respiratory outcome. Level of Evidence 3Laryngoscope, 2020
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| 10. |
- Sundman, Joar, et al.
(författare)
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Sleep Quality After Modified Uvulopalatopharyngoplasty : Results From the SKUP3 Randomized Controlled Trial
- 2018
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 41:1
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: To investigate whether uvulopalatopharyngoplasty (UPPP) improves sleep quality in patients with Obstructive Sleep Apnea (OSA) using the Functional Outcomes of Sleep Questionnaire (FOSQ) and the Karolinska Sleep Questionnaire (KSQ).Methods: Randomized controlled trial used to compare modified UPPP, with controls at baseline and after six months. The controls received delayed surgery and a six-month postoperative follow-up. All operated patients were offered a 24-month follow-up. At each follow-up, patients underwent polysomnography and vigilance testing and completed questionnaires. Nine scales were evaluated: five subscales and the total score in the FOSQ and three subscales in the KSQ.Results: Sixty-five patients, mean 42.3 years (SD 11.5), Friedman stage I and II, BMI <36 kg/m 2, moderate to severe OSA, were randomized to intervention (n = 32) or control (n = 33). In the FOSQ and in the KSQ, the mean rate of missing values was 6.2% (range 0-19%) and 20.5% (3-38%), respectively. In 8 of 9 scales, significant differences were observed between the groups in favor of UPPP. There were significant correlations between results from the questionnaires and objective measures from polysomnography and the vigilance test. At the six and 24-month postoperative follow-ups, 8 of 9 scales were significantly improved compared to baseline.Conclusions: In selected patients with OSA, subjective sleep quality was significantly improved six months after UPPP compared to controls, with stable improvements 24 months postoperatively. The correlations between subjective and objective outcomes, and the long-term stability suggest a beneficial effect from surgery, although a placebo effect cannot be excluded.
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