Successful treatment of oropharyngeal obstructive sleep apnoea with tonsillectomy and limited uvulopalatopharyngoplasty using a pillar apposition and lateralisation technique

Background: Obstructive sleep apnoea (OSA) is a significant public health problem affecting 2–4% of the UK population. We describe our surgical technique for treating ‘oropharyngeal OSA’ and determine its effectiveness based on pre- and post-operative data from our sleep disorders unit. We include subgroup analysis for patients with a pre-operative body mass index (BMI) ≥30 kg/m².

Methods: A retrospective case series of patients undergoing tonsillectomy and limited uvulopalatopharyngoplasty (UPPP) for treatment of oropharyngeal OSA. Data collected pre- and post-operatively include BMI, Epworth Sleepiness Score (ESS), overnight pulse oximetry (3% and 4% SpO₂ dip rates per hour, minimum SpO₂, mean SpO₂) and use of continuous positive airway pressure (CPAP) device. Paired t-tests were used to calculate statistical significance.

Results: Twenty-seven patients (22 male) were analysed. Mean age 44.4 years, mean pre-op BMI 31.6 kg/m² (52% had a BMI ≥30 kg/m²). Mean time from surgery to post-op sleep study is 9.8 months. Overall, mean ESS improved from 11.9 to 8.6 (P<0.005); 3% and 4% dip rates decreased from 28.1/h to 7.3/h and from 22.9/h to 4.7/h respectively (both P<0.00001); minimum SpO₂ improved from 73.02% to 80.29% (P<0.05). Twenty-two patients used CPAP prior to surgery. Only four continued CPAP post-operatively. Patients with a BMI ≥30 had worse pre-operative scores but showed more marked changes in ESS, 3% and 4% SpO₂ dip rates than the BMI <30 group.

Conclusions: Our patients were selected based on overcrowding of the oropharynx secondary to tonsillar hypertrophy and the presence of redundant pharyngeal wall mucosa. By apposing the tonsillar pillars and placing lateralising sutures after tonsillectomy, the oropharyngeal inlet is converted from an isosceles triangle into a wide oval shape. Significant effects on ESS, sleep oximetry and use of CPAP were shown to be even more profound in patients with a BMI ≥30 kg/m².