Combination surgical and mechanical therapy for refractory cases of obstructive sleep apnea

Objective: Our purpose was to investigate the effects of surgical alteration of the soft palate by laser-assisted uvulopalatoplasty (LAUP) on the effectiveness of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea. Specifically, is there any change in effective CPAP pressure after LAUP? Design: Ten patients from a group of LAUP candidates who either failed LAUP treatment as measured by pre- and post-polysomnography or were unable to tolerate CPAP were prospectively evaluated. Patients: Fifty patients were referred to an otolaryngologist for evaluation and treatment of obstructive sleep apnea. Forty-three had LAUP surgery. Five patients had failed LAUP therapy and another five were unable to tolerate CPAP prior to LAUP. Methods: Polysomnography was used to evaluate patients pre- and postoperatively. Polysomnography with CPAP titration was then used to compare the effects of LAUP in combination with CPAP. Results. The average, effective CPAP decreased by 4.8 cm H2O after LAUP. In patients who failed LAUP therapy, CPAP was still found to be effective.