121 - Uvulopalatopharyngoplasty

Summary

Uvulopalatopharyngoplasty (UPPP) is a procedure performed on adults for the treatment of obstructive sleep apnea (OSA). UPPP involves removing the posterior aspect of the soft palate including the uvula and lateral pharyngeal mucosa (or tonsils if present) to reduce redundant tissue, thereby enlarging the oropharyngeal and nasopharyngeal airway.

OSA is a condition affecting 4% of the adult population and manifests by repeated episodes of apnea or hypopnea during sleep. During deeper levels of sleep, especially that characterized by rapid eye movement (REM), there is loss of the normal tone of the pharyngeal and tongue muscles that keep the pharynx open, resulting in collapse of the oropharyngeal and nasopharyngeal airway and varying degrees of airway obstruction. Narrowing of the airway causes increased velocity of inspiratory airflow in the pharynx, causing decreased intraluminal pressure, further tissue collapse, and increased airway obstruction (Bernoulli's principle). In instances of complete airway obstruction, the patient will experience apnea, a cessation of breathing for at least 10 seconds. Incomplete obstruction may result in hypopnea, a reduction in airflow with associated oxygen desaturation, which is more common. Each apnea or hypopnea episode continues until the patient awakens to a more shallow level of sleep, which results in a recovery of pharyngeal muscle tone and recovery of airway integrity. The more frequent the apnea and hypopnea the more fragmented the sleep, resulting in greater sleep deprivation due to the lack of adequate REM activity.