Uvulopalatopharyngoplasty for obstructive sleep apnea

Surgery Overview

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Uvulopalatopharyngoplasty (UPPP) is a procedure that removes excess tissue in the throat to make the airway wider. This sometimes can allow air to move through the throat more easily when you breathe, reducing the severity of obstructive sleep apnea (OSA). The tissues that are removed may include:

• The soft fingerlike tissue that hangs down from the back of the roof of the mouth into the throat (uvula).
• Part of the roof of the mouth (soft palate).
• Excess throat tissue, tonsils, and adenoids.

See pictures of the tonsils, adenoids, and uvula and the hard and soft palates .

If an enlarged tongue is a factor in your sleep apnea, the surgeon may remove a small part of the tongue. This is called an uvulopalatopharyngoglossoplasty.

What To Expect After Surgery

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You may need continuous positive airway pressure therapy (CPAP) therapy after surgery. CPAP therapy uses a breathing device that you wear at night that helps you breathe more easily and prevents your airway from closing during sleep.

Some pain medicines can relax the throat muscles. You may have to avoid these medicines after surgery to make it less likely that your airways will narrow and cause apnea episodes.

Why It Is Done

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Your doctor may suggest UPPP if you:

• Have excess tissue in your nose, mouth, or throat that blocks your airway.
• Choose not to use (or cannot use) CPAP.
• Do not get better after using CPAP.
• Do not want to have an opening made in your windpipe (tracheostomy) to treat sleep apnea.

Children usually do not have UPPP. For them, removing the tonsils and adenoids usually cures sleep apnea.

How Well It Works

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There is no good evidence on how effective UPPP is for obstructive sleep apnea.¹

UPPP may stop snoring, but apnea episodes may continue.²

Limited research shows that about 40% to 60% of people who have UPPP see an improvement in their symptoms.³

Even if surgery successfully removes the blockage, you may still need CPAP after surgery.

Risks

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Complications during surgery include accidental damage to surrounding blood vessels or tissues.

Complications after surgery may include:

• Sleepiness and periods of not breathing (apnea) related to the medicines that are used to relieve pain and help you sleep.
• Swelling, pain, infection, or bleeding.
• Speech problems. The surgery may result in a nasal quality to the voice.
• Narrowing of the airway in the nose and throat.

What To Think About

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Before considering surgery, you should try CPAP.

You will need a sleep study after UPPP surgery to find out if your sleep apnea has improved. If you still stop breathing at night, you may still need CPAP.

Laser-assisted uvulopalatoplasty is sometimes used to treat mild to moderate obstructive sleep apnea, although not all people benefit. This procedure is not approved by the American Academy of Sleep Medicine to treat sleep apnea.⁴

People who are obese or who have some other illnesses are more likely to have complications after UPPP.⁵

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Sundaram S, et al. (2006). Surgery for the treatment of obstructive sleep apnoea. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

2. Malhotra A, White DP (2002). Obstructive sleep apnea. Lancet, 360(9328): 237–245.

3. Guilleminault C, Abad VC (2004). Obstructive sleep apnea syndromes. Medical Clinics of North America, 88(3): 611–630.

4. Littner M, et al. (2001). Practice parameters for the use of laser-assisted uvulopalatoplasty: An update for 2000. Sleep, 24(5): 603–619.

5. Kezirian EJ, et al. (2006). Risk factors for serious complication after uvulopalatopharyngoplasty. Archives of Otolaryngology—Head and Neck Surgery, 132(10): 1091–1098.

Credits

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Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Jan Ulfberg, MD, PhD - Sleep Disorders
Last Updated	July 13, 2007