Predicting patient-reported outcomes of radiofrequency uvulopalatoplasty with tonsillectomy in adult obstructive sleep apnea.

PURPOSE

Uvulopalatopharyngoplasty with tonsillectomy is one of the most commonly performed procedures for sleep-disordered breathing, with most studies focusing on objective sleep measurement outcomes. Daytime sleepiness and snoring are important patient-reported outcome measures (PROMs); however, little is known about patient-specific predictors to individualize treatment and guide patient counseling.

METHODS

Patients undergoing radiofrequency uvulopalatoplasty with tonsillectomy between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical head and neck examination. Preoperatively and three months after surgery, sleep apnea testing and questionnaires were administered. Daytime sleepiness and snoring were evaluated using the Epworth Sleepiness Scale (ESS) and a visual analog scale (VAS, 0-10) preoperatively and three months postoperatively. Primary endpoints were predictors influencing ESS and snoring reduction.

RESULTS

In total, 142 patients with a mean age of 47 ± 12 years have been analyzed. ESS significantly decreased from 8.4 ± 4.7 to 4.1 ± 3.0 (p < 0.01), and snoring VAS from 7.9 ± 2.0 to 3.3 ± 2.3 (p < 0.01). Higher preoperative ESS and snoring scores significantly predicted greater postoperative improvements. Anatomical parameters and indices from sleep studies did not consistently predict outcomes. A greater reduction in the apnea-hypopnea index was associated with ESS reduction but not with snoring intensity improvements.

CONCLUSION

Radiofrequency uvulopalatoplasty with tonsillectomy significantly reduces daytime sleepiness and snoring severity in adult patients with sleep-disordered breathing. Baseline symptom severity was the sole consistent predictor for PROM improvements, highlighting the multifactorial nature of subjective outcomes and underscoring the necessity for individualized patient counseling and expectation management.