A randomized clinical trial compared the efficacy of tonsillectomy (TE) and modified uvulopalatopharyngoplasty (mUPPP) for the treatment of obstructive sleep apnea (OSA) in adult patients. Results showed similar outcomes between each intervention group, but with minor non-clinically relevant differences.
Tosillectomy is less extensive than a modified uvulopalatopharyngoplasty surgery. The investigators, led by his Joar Sundman, MD, PhD, in the Karolinska Institutet’s Department of Clinical Sciences, Interventions and Technology, aimed to determine whether one intervention was superior to another.
Approaches involving continuous positive airway pressure (CPAP) and mandibular retention devices (MRD) are potentially effective first-line options, but are limited to patient adherence. Adherence to these non-surgical options continues to cause problems due to poor or inappropriate patient use.
Information collected from 90 adult patients with tonsillar hypertrophy and moderate to severe obstructive sleep apnea was used in a blinded, randomized clinical trial. The timeline for surgery was between January 2016 and he February 2021.
Patient monitoring began preoperatively and definitive follow-up was performed 6 months after surgery. In addition to moderate or severe obstructive sleep apnea, patients had tonsillar hypertrophy ranging from 2 to 4 according to Friedman staging.
The primary outcome was measured by the between-group difference in the Apnea Hypopnea Index (AHI) and the Epworth Sleepiness Scale (ESS). The mean age of the study population he was 41.6 years and the majority (86%) were male. Results showed an average body mass index (BMI) of 29.0.
Both study groups experienced improvement, but the differences between groups were not clinically relevant.
Patients in the mUPPP group had a 43% reduction in AHI score. Initially, this group had him reporting 51 events per hour, but after surgery he decreased to 28 events per hour. As for the tonsillectomy group, the investigators observed his 56% reduction in his AHI score, with 56.9 events per hour at baseline and 24.7 events per hour at follow-up.
Analysis revealed a mean difference of 9.2 events per hour between groups in favor of the TE group. However, the effect size was small (Cohen d= 0.44). The difference in ESS scores was also the smallest between groups at 1.1 (Cohen d= 0.21), so neither difference is significant.
“This randomized clinical trial showed that mUPPP is no more effective than TE alone in treating patients with tonsillar hypertrophy and moderate-to-severe OSA,” the researchers concluded. “However, there were minor differences in favor of TE. TE alone is not widespread and can be considered an alternative to mUPPP in this select group of OSA patients.”
The study “Efficacy of tonsillectomy vs. modified uvulopalatopharyngoplasty in patients with tonsillar hypertrophy and obstructive sleep apnea” was published in . JAMA Otolaryngology – Head and Neck Surgery.