I am writing to comment on the article by Finkelstein and colleagues1 published in the April 2002 issue of the ARCHIVES. I believe that the conclusions presented are not justified from the data. The authors present a series of 26 patients, from an apparently unselected series, who were treated for snoring and obstructive sleep apnea (OSA). First, there is no mention of patients lost to follow-up. Apparently all the patients completed treatment and received postoperative evaluation, although this is unclear given the authors' 1997 publication2 of an anatomical study of 74 patients treated with laser-assisted uvulopalatoplasty (LAUP) during a similar time frame. We are left to wonder how these patients fared and whether they are included in the current report. Second, treating an unselected series of sleep apnea patients with LAUP alone will obviously result in poor outcomes. From the published data, success rates using uvulopalatopharyngoplasty (UPPP) on an unselected series are approximately 40%,3 and thus the 31% reported in this study is hardly surprising. If a LAUP is performed on a patient with OSA who has a large tongue and a normal palate, then a failure to change the respiratory disturbance index (RDI) is easy to predict. Furthermore, if patients with borderline OSA are included in a study such as this, surgical success may be difficult to interpret. It is difficult to demonstrate a 50% decrease in the RDI (the authors' definition of success) when the preoperative index is only 9!
Kern RC. LAUP Reconsidered. Arch Otolaryngol Head Neck Surg. 2003;129(4):494–495. doi:10.1001/archotol.129.4.494
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