What are the reported outcomes following uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA)?

Updated: Dec 09, 2020
  • Author: Eelam Aalia Adil, MD, MBA; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Initially, the success rate of UPPP was reported to be less than 40%, with success defined as a reduction of respiratory disturbance index by 50% and an apnea-hypopnea index less than 10 or a respiratory disturbance index less than 20. [6] However, this low success rate was probably related to patient selection.

The Friedman staging system based on palate position, tonsil size, and body mass index was then established to aid with patient selection. [7, 8] Stage I patients had a palate size of 1 or 2 based on a modified Mallampati scale and tonsil size of 3 or 4 based on the Brodsky scoring system. These patients are the best candidates for surgery with a reported success rate of 80.6%. Stage II patients have a palate position and tonsil size of 3 or 4. Their success rate following uvulopalatopharyngoplasty was 37.9%. One meta-analysis found that Friedman stage I is a strong predictor for success after UPPP, while Friedman stage III and low hyoid position are negative predictors. [9]

Patients with a body mass index greater than 40 kg/m2 were classified as stage III and had a success rate of only 8.1%. These findings reiterate the need for proper patient selection and counseling prior to surgery.


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