Modified uvulopalatopharyngoplasty in modern obstructive sleep apnea treatment: a narrative review.

Abstract

Study objectives: Obstructive sleep apnea (OSA) is a prevalent disorder associated with significant health risks, often managed with continuous positive airway pressure (CPAP). However, CPAP adherence remains suboptimal, prompting interest in surgical alternatives. Traditional uvulopalatopharyngoplasty (UPPP), introduced in 1981, has demonstrated limited success and notable side effects, leading to skepticism regarding its utility in OSA treatment. However, advancements in patient selection and surgical technique have led to the development of modified UPPP procedures, including expansion sphincter pharyngoplasty, barbed reposition pharyngoplasty, and the Australian modified UPPP.

Methods: In this narrative review, we focus on the evolution of the palatal surgery field over the past two decades.

Results: Recent randomized controlled trials and observational cohort studies have shown that modified UPPP variants can significantly reduce apnea-hypopnea index (AHI), improve symptoms, and even offer potential cardiovascular benefits. These reconstructive approaches have demonstrated consistently improved success rates, enhanced patient-reported outcomes, and reduced postoperative morbidity compared to traditional excisional UPPP.

Conclusions: While controversies persist regarding patient selection, long-term durability, and the role of palate surgery in the era of hypoglossal nerve stimulation, emerging evidence supports modified UPPP as a viable alternative for appropriately selected OSA patients. This review underscores the evolution of palatal surgery, highlighting its role in a personalized, multimodal approach to OSA management, particularly for CPAP-intolerant patients seeking durable and effective treatment.