Obstructive sleep apnoea (OSA) is a recognised condition that is increasing in prevalence, affecting the quality of life in certain individuals. Although the first line management is non-surgical, this paper highlights the two different surgical procedures offered to patients. The authors carried out a randomised controlled trial (RCT) of whether the tonsillectomy alone or with modified uvulopalatopharyngoplasty (mUPPP) was superior to the other. Adult patients were selected according to their tonsil size score of two or more, failure of non-surgical treatment and apnoea-hypopnea index (AHI) score of more than 15 events per hour. All 90 participants were randomised, blinded and underwent a polysomnography and completed the Epworth Sleepiness Scale (ESS). The groups were operated on then followed up six months later with their AHI score and repeat ESS questionnaire. Unfortunately, due to COVID-19, the sample size was much smaller than expected during prospective data collection, therefore reducing the power of the study. Nevertheless, the conclusion would remain the same. The average percentage decrease in AHI in those undergoing tonsillectomy was 56% compared to 43% who had mUPPP. This indicated tonsillectomy being the favoured surgery for these selective patients. Although the ESS questionnaire score reduced from baseline to six months in both groups, it was not significant. One would expect more extensive surgery to be more effective than less, however the authors concluded that the findings from the study were surprisingly against their hypothesis, in that mUPPP was not more effective than the less extensive tonsillectomy alone in treating OSA. Despite recognising the limitations of the study, the readers could still consider tonsillectomy as the less extensive surgical option for moderate to severe OSA patients. Understanding the long-term effectiveness is paramount for those who underwent OSA surgery. Therefore, as described, a five-year follow-up is welcomed.
Which surgical procedure is more effective in treating OSA? Tonsillectomy or modified uvulopalatopharyngoplasty?
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