The Efficacy of Oral Appliances in the Treatment of Persistent Sleep Apnea After Uvulopalatopharyngoplasty*

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Abstract

Twenty-four patients who failed uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) had an adjustable oral (Herbst) appliance made to treat the persistent apnea. Six patients discontinued the device prior to sleep evaluation. Eighteen patients had polysomnographic evaluations at baseline, post-UPPP, and with the Herbst appliance in place. The apnea-hypopnea index baseline (AHI) and arterial oxygen saturation (SaO2) nadir were 42.3 +/- 6.1 and 83.6 +/- 1.8%, respectively. There was no significant change in either parameter with surgery. With the oral appliance, the AHI fell to 15.3 +/- 4.4 (p50% fall in AHI compared with baseline and post-UPPP values. All but one of the responders and partial responders had complete resolution of subjective symptoms of daytime sleepiness with the appliance. An adjustable oral appliance appears to be an effective mode of therapy to control OSA after an unsuccessful UPPP. (CHEST 1998; 113:992-96)

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