Effectiveness of Uvulopalatoplasty and Nasal Surgery in OSAS Patients

Document Type : Original


1 Department of ENT, Yerevan State Medical University, “Erebouni” Medical Center, Yerevan, Armenia.

2 Unimed Medical Centre, Yerevan- Armenia.

3 Institute of Cardiology Named after Levon Hovhannisyan, Yerevan-Armenia.


This study aims to evaluate the effectiveness of simultaneous uvulopalatoplasty and nasal surgery in patients with moderate obstructive sleep apnoea syndrome.
 Materials and Methods:
We studied 48 patients with obstructive sleep apnoea syndrome and nasal breathing disorders. The 1st group of 20 patients underwent septoplasty and volumetric tissue reduction of inferior turbinates and the 2nd group of 28 patients underwent septoplasty, volumetric tissue reduction of inferior turbinate, uvulopalatoplasty.
In the 1st group, the pre-operative apnoea-hypopnea index median decreased from 22.1 ep/h to 14.9 ep/h after the surgery. Pre-operative median of nasal airflow volume grew from 167.0 cm3 to 609.5 cm3 post-operatively and the loudness of snoring decreased from 2.7±0.2 to 0.7±0.2. In the 2nd group, the apnoea-hypopnea index median decreased from 20.4 ep/h to 5.3 ep./h. The pre-operative median of nasal airflow volume grew from 189.5 cm3 to 519.5 cm3 post-operatively and the  loudness of snoring improved from 2.6±0.2 pre-op to 1.1±0.2.
 Patients with moderate obstructive sleep apnoea syndrome and nasal breathing disorders are advised to have nasal surgery combined with uvulopalatoplasty for a better outcome.


Main Subjects

  1. American sleep disorders association international classification of sleep disorders (ICSD): Diagnostic and Coding Manual. American Sleep Disorders Association, Rochester, Minnesota, 1997; 21-4.
  2. Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl. J. Med. 2002; 347:498-504. https:// org/10.1056/NEJMcp012849.
  3. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine. 2009 Jun 15;5(3):263-76.
  4. Schwartz RN, Payne RJ, Forest VI, Hier MP, Fanous A, Vallée-Gravel C. The relationship between upper airway collapse and the severity of obstructive sleep apnea syndrome: a chart review. Journal of Otolaryngology-Head & Neck Surgery. 2015 Dec; 44:1-7.
  5. Migueis DP, Thuler LC, Lemes LN, Moreira CS, Joffily L, Araujo-Melo MH. Systematic review: the influence of nasal obstruction on sleep apnea. Brazilian journal of otorhinolaryngology. 2016 Mar; 82: 223-31.
  6. Verse T, Wenzel S. Treating nasal obstruction in obstructive sleep apnea patients. 2017; 65: 117-124. https://doi.org/10.1007/s00106-016-0269-9.
  7. Magliulo G, De Vincentiis M, Iannella G, Ciofalo A, Pasquariello B, Manno A, Angeletti D, Polimeni A. Olfactory evaluation in obstructive sleep apnoea patients. Acta Otorhinolaryngologica Italica. 2018 Aug; 38(4):338.
  8. Cai Y, Goldberg AN, Chang JL. The Nose and Nasal Breathing in Sleep Apnea. Otolaryngol Clin North Am. 2020; 53:385-95. https://doi.org/ 1016/j.otc.2020.02.002.
  9. Virkkula P, Bachour A, Hytönen M, Salmi T, Malmberg H, Hurmerinta K, Maasilta P. Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest. 2006 Jan 1;129(1):81-7.
  10. Bury SB, Singh A. The role of nasal treatments in snoring and obstructive sleep apnoea. Curr Opin Otolaryngol Head Neck Surg. 2015;23:39-46. https://org/10.1097/MOO.0000000000000129.
  11. Friedman M, Ibrahim H, Joshph NJ (2004) Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 114: 454-459.
  12. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667-89.
  13. Vogt K, Jalowayski AA, Althaus W, Cao C, Han D, Hasse W, Hoffrichter H, Mösges R, Pallanch J, Shah-Hosseini K, Peksis K. 4-Phase-Rhinomanometry (4PR)--basics and practice 2010. Rhinology. Supplement. 2010 Jan 1;21:1-50.
  14. Park S. Flow-regulatory function of upper airway in health and disease: a unified pathogenetic view of sleep-disordered breathing. Lung 1993; 171:311-33. https://org/10.1007/BF00165698.
  15. Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 2011;268:1365–73. https:// org/10. 1007/ s00405-010-1469-7.
  16. Wu J, Zang HR, Wang T et al. Evaluation of the subjective efficacy of nasal surgery. J Laryngol Otol 2017; 131: 37–43. https://doi .org/10. 1017/ S0022215116009609.


  1. Sabbe AV, De Medts J, Delsupehe K. Surgical treatments for snoring. B-ENT 2017; 13: 1–7.
  2. Low WK. Can snoring relief after nasal septal surgery be predicted? Clin Otolaryngol Allied Sci. 1994; 19: 142-44. https://org/10.1111/j.1365-2273. 1994. tb01199.x.
  3. Ellis PD, Harries ML, Williams JF, Shneeerson JM. The relief of snoring by nasal surgery. Clinical otolaryngology & Allied Sciences. 1992 Dec; 17(6): 525-7.
  4. Koutsourelakis I, Georgoulopoulos G, Perraki E, Vagiakis E, Roussos C, Zakynthinos SG. Randomised trial of nasal surgery for fixed nasal obstruction in obstructive sleep apnoea. European Respiratory Journal. 2008 Jan 1;31(1):110-7.
  5. Li HY, Lin Y, Chen NH, Lee LA, Fang TJ, Wang PC. Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction. Archives of Otolaryngology–Head & Neck Surgery. 2008 Apr 1;134(4):429-33.
  6. Li HY, Wang PC, Chen YP, Lee LA, Fang TJ, Lin HC. Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea. American Journal of Rhinology & Allergy. 2011 Jan;25(1):45-9.
  7. Lim DJ, Kang SH, Kim BH et al. Treatment of Obstructive Sleep Apnea Syndrome Using Radiofrequency-Assisted Uvulopalatoplasty With Tonsillectomy. Eur Arch Otorhinolaryngol 2013; 270:585-93.https://doi.org/10.1007/s00405-012-2082-8.
  8. Bassiouny A, El Salamawy A, Abd El-Tawab M, Atef A. Bipolar radiofrequency treatment for snoring with mild to moderate sleep apnea: a comparative study between the radiofrequency assisted uvulopalatoplasty technique and the channeling technique. European archives of oto-rhino-laryngology. 2007 Jun; 264:659-67.
  9. Choi JH, Kim EJ, Cho WS, Kim YS, Choi J, Kwon SY, Kim TH, Lee HM, Lee SH, Lee SH. Efficacy of single-staged modified uvulopalato- pharyngoplasty with nasal surgery in adults with obstructive sleep apnea syndrome. Otolaryngology--Head and Neck Surgery. 2011 Jun;144(6):994-9.
  10. https://org/10.1177/0194599811398194.
  11. Verse T, Hörmann K. The Surgical Treatment of Sleep-Related Upper Airway Obstruction. Dtsch Arztebl Int. 2011; 108:216–21. https://doi.org/10. 3238/arztebl.2010.0216.