Tonsillectomy alternative to Modified uvulopalatopharyngoplasty for selective patients with OSA: TEAMUP Study
Obstructive sleep apnea (OSA) is associated with several adverse health effects, such as increased mortality and morbidity in cardiovascular diseases and vehicle crashes. In addition, patients with OSA experience poor quality of life and daytime sleepiness.
The first line of treatment is nonsurgical, with continuous positive airway pressure (CPAP) or a mandibular retaining device (MRD). These approaches are often effective, but adherence to treatment remains a challenge because many patients use them insufficiently or not at all. For these patients, pharyngeal surgery may be an option, as recommended in a recent review by the American Academy of Sleep Medicine (AASM).
A common surgical procedure for OSA is uvulopalatopharyngoplasty (UPPP). Although different definitions exist, UPPP usually includes a tonsillectomy (TE) and a uvulopalatoplasty: suturing the palatal pillars and reducing the size of the uvula. Some early UPPP techniques extensively reduced the palatal tissues and were associated with significant adverse effects.
In children, TE alone is the standard treatment for OSA and is often effective. However, in adults, TE alone has traditionally not been considered an alternative for sleep apnea surgery, probably as tonsil hypertrophy is unusual in adults. Because mUPPP is expected to widen the airways by suturing the palatal pillars and the palatopharyngeus muscle laterally and is performed in addition to a TE, authors Joar Sundman and team presumed it to be a more effective treatment than a TE alone. They carried a RCT that aimed to compare the effectiveness of mUPPP with that of TE among a population of selected patients with medium to large tonsils (sizes 2, 3, or 4, per the Friedman scale) and moderate to severe OSA—the hypothesis being that the results of mUPPP would be superior to those of TE alone.
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