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Clinical Challenges
June 1998

More Data Needed

Author Affiliations
 

KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD

Arch Otolaryngol Head Neck Surg. 1998;124(6):722. doi:10.1001/archotol.124.6.722

TERRIS and Wang should be applauded for their efforts in reviewing several hundred articles dealing with LAUP. They must have spent many hours reviewing raw data from several articles.

It is revealing that only 10 of some 50 articles presented polysomnographic data addressing the efficacy of LAUP for sleep-related breathing disorders. Snoring is a clue to a much more serious disorder: OSA. It is disturbing to note the lack of objective data presented in the literature.

Obesity is an important factor in sleep-related breathing disorders.1 The authors found only 3 studies that provided data on body mass index. Patients might have had significant changes in their weight, which could affect the results of any surgical interventions.

Also, there is no mention of the patient's oropharyngeal anatomy, especially the presence of large tonsils. It has been demonstrated that tonsils can significantly contribute to sleep-related breathing disorders.2 Procedures intended to improve sleep-related breathing disorders should address characteristics of the tonsils.

While it does appear appropriate to offer LAUP for mild OSA based on the available data, we should challenge our colleagues and our Academy to continue to sponsor prospective studies that include data such as sex, race, body mass index, and objective polysomnographic data so that we can improve our patient selection and therefore the results of LAUP.

References
1.
Loube  DILoube  AAMitler  MM Weight loss for obstructive sleep apnea: the optimal therapy for obese patients.  J Am Diet Assoc. 1994;941291- 1295Google ScholarCrossref
2.
McGuirt  WF  JrJohnson  JTSanders  MH Previous tonsillectomy as prognostic indicator for success of uvulopalatopharyngoplasty.  Laryngoscope. 1995;1051253- 1255Google ScholarCrossref
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