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Home / Sleep Disorders / Sleep Apnea / Uvulopalatopharyngoplasty (UPPP) Surgery

Uvulopalatopharyngoplasty (UPPP) Surgery

Rob Newsom

Written by

Rob Newsom, Staff Writer

Dr. Anis Rehman

Medically Reviewed by

Dr. Anis Rehman, Endocrinologist

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As many as 30% of adults and 5% of children in the United States have obstructive sleep apnea (OSA). This common sleep disorder causes disruptions in breathing during sleep and, if left untreated, can reduce sleep quality and contribute to a myriad of health consequences.

In people with OSA, abnormal breathing occurs when tissue within the upper airway collapses in on itself, creating an obstruction. Researchers believe that obstructions develop due to a combination of individual susceptibility and natural changes that occur in the muscles of the airway during sleep.

To resolve nighttime breathing disruptions, treatment for OSA may facilitate breathing with positive airway pressure (PAP) therapies while addressing factors that can increase the risk of obstructions including excess weight and sleep position. When these treatments are not successful in reducing the symptoms of OSA, doctors may recommend alternative treatments including surgery for sleep apnea.

There are a variety of surgeries for OSA that can widen the airway or make it less likely to collapse during sleep. The most frequently performed surgery for adults with OSA is uvulopalatopharyngoplasty (UPPP or UP3). We discuss this surgery, including its role in treating OSA, its potential benefits and risks, and what to expect before and after the procedure.

What is UPPP Surgery?

Uvulopalatopharyngoplasty is a surgery that removes and repositions tissue within the airway to make it less likely to collapse and interfere with breathing during sleep. UPPP enlarges the airway by focusing on changing tissue in the throat such as the soft palate, uvula, and tonsils.

  • Soft palate: The soft palate is located at the back of the roof of the mouth and is important for breathing, swallowing, and speaking. More than 90% of airway obstructions during sleep may be related to blockages caused by the soft palate.
  • Uvula: The soft palate ends at a piece of tissue hanging from the roof of the mouth called the uvula. Because a swollen or enlarged uvula is another frequent cause of airway obstruction, this tissue is often altered or removed during a UPPP.
  • Tonsils: The tonsils are tissues found on both sides of the back of the throat that play a role in preventing infection. Larger than normal tonsils are another reason for reduced space in the airway and are a common target of surgery.

A UPPP surgery is composed of several procedures, each targeting specific structures or abnormalities in the airway that contribute to obstructions during sleep.

Variations of UPPP

The choice of which procedures to include during a uvulopalatopharyngoplasty depends on the results of an examination of the mouth and airway as well as an individual’s unique anatomy.

  • Tonsillectomy: A tonsillectomy is a procedure in which the tonsils are removed.
  • Adenoidectomy: The adenoids are tissues that play a role in preventing infection and are located behind the nose at the top of the throat. When these tissues are removed during surgery, it is called an adenoidectomy.
  • Uvulopalatal flap: A uvulopalatal flap procedure involves folding the uvula under the soft palate rather than removing it completely.
  • Expansion sphincter pharyngoplasty: This procedure attempts to reinforce the side walls of the airway by removing or repositioning tissues within the throat.
  • Palatal advancement pharyngoplasty: During a palatal advancement pharyngoplasty, a doctor removes a portion of the hard palate, which is the front two-thirds of the roof of the mouth. This helps adjust the soft palate forward and reduce the risk of airway collapse.
  • Relocation pharyngoplasty: Relocation pharyngoplasty repositions tissues in the throat to create tension on the sides of the airway and decrease the likelihood of collapse.

In the past, UPPP involved primarily removing tissue to expand the airway. Newer variations of UPPP have helped reduce the side effects of the surgery by attempting to reposition or rebuild tissues when possible.

 

UPPP Surgery for Obstructive Sleep Apnea

Doctors typically recommend uvulopalatopharyngoplasty surgery for the treatment of obstructive sleep apnea when less invasive treatments have been unsuccessful. When surgery is indicated, UPPP is the most frequently performed procedure for adults with OSA.

The effectiveness of UPPP varies based on the part of the airway where obstructions occur and the specific surgical procedures performed. While this surgery can often reduce breathing disruptions and other symptoms of OSA, complete resolution of symptoms is uncommon.

UPPP is not commonly performed in children with OSA. It is more common for children diagnosed with OSA to have the adenoids and tonsils removed to reduce breathing problems during sleep. However, pediatricians may recommend UPPP in children with certain health conditions, such as Down syndrome.

Because of a lack of research about their effectiveness and the potential for side effects, UPPP and other surgeries for OSA are not recommended for pregnant people.

UPPP Surgery for Snoring

Although not an initial treatment for snoring, uvulopalatopharyngoplasty may be recommended if snoring has not gotten better after less invasive treatments and is caused by anatomic features that may be addressed by surgery.

UPPP surgery may be able to reduce snoring because the cause of snoring is often a mild version of the changes in the airway that occur in people with obstructive sleep apnea. People who snore have a partial narrowing of the airway. When air moves past tissues in the throat, those tissues vibrate and create the characteristic sounds of snoring.

While most people experience a reduction in snoring after a UPPP, only around half maintain this improvement long-term. UPPP is also an invasive procedure that involves receiving anesthesia and staying in a hospital overnight, so the drawbacks of the procedure often outweigh its benefits for people who snore but do not have sleep apnea.

Benefits and Drawbacks of UPPP Surgery for Obstructive Sleep Apnea

When deciding whether to pursue surgery for obstructive sleep apnea, it can be helpful to understand the benefits and drawbacks of UPPP.

Although past research can help people understand what to expect from surgery, it is important to remember that the specific procedures involved in a uvulopalatopharyngoplasty depend on an individual’s needs. Because variations of UPP can affect the surgery’s outcome, it is important to discuss questions about the benefits and drawbacks with a doctor.

Benefits of UPPP

The benefits of uvulopalatopharyngoplasty surgery depend on several factors, including the cause of airway obstructions and the procedures involved in the UPPP. In general, around half of people who undergo UPPP experience significantly fewer breathing disruptions during sleep after the operation. Other benefits of UPPP surgery can include:

  • Reduced snoring
  • Fewer nighttime awakenings
  • Less daytime sleepiness
  • Lower risk of accidents while driving
  • Decreased risk of cardiovascular disease
  • Improvements in overall quality of life

Drawbacks of UPPP

Potential side effects of uvulopalatopharyngoplasty include post-surgical pain, bleeding, and risk of infection. People who have UPPP surgery may also experience changes in their voice as well as temporary difficulty making certain sounds.

As many as one-third of people develop difficulties related to swallowing and eating after UPPP surgery. Serious side effects of UPPP are uncommon, and the majority of people see improvements in side effects during the first few months after the procedure.

While many people with obstructive sleep apnea experience improvements in their symptoms after a UPPP surgery, some people find that OSA comes back over time. Also, UPPP may not eliminate the need for other treatments such as continuous positive airway pressure (CPAP), and people often need to continue these treatments after the procedure.

Will UPPP Be Covered by Insurance?

Insurance may cover the cost of uvulopalatopharyngoplasty, but this depends on a person’s health insurance policy. For people with private medical insurance, contacting the insurance company directly is the best way to learn about what costs may be covered and what may need to be paid out of pocket.

For individuals with Medicare, uvulopalatopharyngoplasty is only covered under specific circumstances. Surgery must be needed for the treatment of moderate to severe obstructive sleep apnea that is caused by blockages in certain parts of the airway. For coverage to apply, less invasive treatments, such as CPAP therapy, must be attempted first, and a doctor must have a conversation with the patient about the risks and benefits of surgery.

Preparing for UPPP Surgery

Knowing what to expect before and after surgery may reduce anxiety about surgery and can help people stay informed about their follow-up care plan.

Before UPPP Surgery

Prior to surgery, doctors evaluate a person’s health history and perform testing to determine whether they are a good candidate for uvulopalatopharyngoplasty. The primary care doctor may work directly with a surgeon to determine whether surgery is a safe and beneficial option. Doctors may also use this time to discuss other options for treating OSA and what to expect if a person goes forward with surgery.

An exam of the head and neck as well as imaging tests may be used to find the location of the obstruction and develop a plan for surgery. Because uvulopalatopharyngoplasty is performed under general anesthesia, additional tests may be performed to ensure that the surgery can be performed safely.

People scheduled for UPPP surgery should take standard precautions prior to surgery, including telling their doctor about any medications or supplements they take and informing the doctor if they could be pregnant. A doctor, nurse, or another medical professional will review any additional pre-operative instructions and what to expect prior to the day of surgery.

After UPPP Surgery

After waking up from uvulopalatopharyngoplasty, people are monitored by a medical professional while the side effects of anesthesia diminish. An overnight hospital stay is often needed to make sure that a person can swallow before they are discharged.

Recovery from UPPP surgery can take two to three weeks, during which time people will be instructed to take any pain medication provided by the doctor, eat soft foods, rinse their mouth after meals, and avoid strenuous activity. During recovery, the symptoms of obstructive sleep apnea may temporarily become more severe due to swelling and challenges in using positive airway pressure devices.

During the recovery period, it is important to call a doctor if there are any unexpected side effects. While many people have a follow-up appointment with their doctor after two to three weeks, the timing of this appointment depends on the type of UPPP surgery that was performed.

Follow-up appointments may include an examination of the surgical site to check the wound and assess the airway. The doctor will also ask about any changes in symptoms or new side effects.

After several months, people typically meet with a sleep specialist for a follow-up sleep study to detect and measure any remaining symptoms of OSA and to discuss any need for ongoing treatment, such as continued use of a CPAP device.

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About Our Editorial Team

author
Rob Newsom

Staff Writer

Rob writes about the intersection of sleep and mental health and previously worked at the National Cancer Institute.

author
Dr. Anis Rehman

Endocrinologist

MD

Dr. Rehman, M.D., is a board-certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism.

References

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