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Plasma Radiofrequency Prededed by Pressure Recording Enhances Success for Treating Sleep-Related Bre |
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Tvinnereim M, et al. Laryngoscope, April 2007;117(4):731-736
This study was done to show how well they are able to select patients for CAUP. This is prospective (the study followed patients as opposed to looking back at results) but there is no comparison group. This paper is what I refer to as a “this is how we do it and it works” paper.
They followed 40 patients with snoring (6) or mild to moderate sleep apnea (34) with an AHI less than 20 and BMI less than 30. Snoring was ranked from 1 to 10 by the bed partner. The patients were selected for the procedure based on their exam as well as pressure recording during a full night, in lab sleep study (a level one study). The pressure recordings were used to identify the primary site of obstruction. If more than 50% of the obstruction was suspected to be behind the soft palate based on these recordings, patients were offered a CAUP procedure and included in the study.
The technique used is identical to the one I perform in my clinic and the one seen on the video link under the CAUP heading.
Results
The results of this study are impressive. They followed them for 7 to 15 months after the surgery (which is longer than studies on other procedures). There was no scarring, no fibrosis, and no significant complications in any patient.
Before the procedure, the average person snored 8/10 on the scale ranked by bed partners. After the surgery, the average ranking was 2.8/10. All patients had at least a 3 point improvement.
Nobody had worsening of sleep apnea after the CAUP. The average improvement was about 40%. In this group, about 20% of people needed a follow-up procedure to get their AHI less than 5.
My thoughts
Forty patients were included in the study, which is adequate. It would be nice to see a follow-up study with more patients included.
The real take home message of this study is how well the CAUP works. They recorded airway pressures to select patients and document results, which I don't believe is necessary (especially since there was no comparison group). In my clinic, a thorough exam with pharyngoscopy during snoring maneuvers is giving similar results.
It would have been nice if they asked how many people were happy with the result but I think it is safe to assume most would be happy when looking at the outcome.
This is the first surgical study I have seen with such an optimistic goal. Most other studies are defining success as an AHI < 20 and a 50% reduction in AHI. The fact that their goal is an AHI < 5 demonstrates their confidence in this procedure.
This is the study which convinced me to start the procedure in my practice and I have been very happy with it. My own results will be published once the long term data is available.
Comments
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CAUP Research 
