Identifying predictors of patient satisfaction following uvulopalatopharyngoplasty

Obstructive sleep apnea (OSA) is a prevalent sleep disorder leading to serious health consequences. While positive airway pressure therapy is the gold standard, it has limitations like low compliance. Surgical options like Uvulopalatopharyngoplasty (UPPP) offer an alternative treatment with the potential for improved adherence. While UPPP generally demonstrates high patient satisfaction, factors influencing this satisfaction remain unclear. This study aims to identify and analyze the factors contributing to patient satisfaction with UPPP surgery for OSA, facilitating improved patient selection and counseling.

This retrospective study included 36 patients who underwent modified UPPP, with hyoid suspension in select cases. Preoperative assessments included polysomnography, drug-induced sleep endoscopy (DISE), snoring severity, Epworth Sleepiness Scale (ESS), body mass index (BMI), neck circumference, Friedman tongue position and Friedman tonsil grading. Post-operative one-year assessments included patient-reported satisfaction, BMI, neck circumference, ESS, snoring severity, and sleep study.

Patients with circumferential velar collapse during DISE tended to have lower post-surgical satisfaction compared to those with anterior-posterior collapse (p = 0.05), with mean satisfaction scores of 53.6 (SD 26.8) and 71.1 (SD 30.3), respectively. Post-surgical satisfaction significantly correlated with pre-operative AHI (ρ=-0.484, p = 0.003), pre-operative mean O2% (ρ = 0.341, p = 0.042), pre-operative T90% (ρ=-0.496, p = 0.002), post-operative snoring severity (ρ=-0.568, p < 0.001), post-operative AHI (ρ=-0.591, p < 0.001), neck circumference (ρ=-0.33, p = 0.049), and tongue collapse grade at DISE (ρ = 0.407, p = 0.014). In a multivariate linear regression model, post-operative AHI (beta= -3.4, p = 0.002) and post-operative snoring severity (beta= -2.7, p = 0.012) remained significant predictors. In UPPP with hyoid suspension, post-operative satisfaction was positively correlated with the severity of tongue collapse.

Lower preoperative AHI and smaller neck circumferences were associated with higher satisfaction. Circumferential velar collapse may negatively impact satisfaction. Severe tongue collapse during DISE suggests that hyoid suspension alongside UPPP should be considered. These findings highlight the importance of preoperative assessment, including DISE, in identifying patients who may benefit most from UPPP and in guiding surgical decision-making.