Laser-assisted uvulopalatopharyngoplasty
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Laser-assisted uvulopalatopharyngoplasty (or LAUP) is a variation of Uvulopalatopharyngoplasty, in which a laser is used to remove tissue rather than a scalpel. At the present time, LAUP is sometimes used in an attempt to address loud snoring. It has no efficacy in surgically managing sleep apnea.
LAUP became popular during the 1980s when it was aggressively marketed as a so-called "cure" for snoring. It was first emloyed by Kamami, a Japanese surgeon on mostly female patients who were of slender build. Early results seemed favourable, and studies of flawed methodology were published. The practice of using lasers to address snoring became widespread. During the late 1990s, researchers (including Finkelstein, Schmidt and others) published data which showed that in a considerable number of cases, laser-assisted uvulopalatoplasty may also cause mild obstructive sleep apnea (OSA) in patients who formerly were nonapneic snorers, or lead to deterioration of existing apnea. These results are attributable to thermal damage inflicted by the laser beam. The laser may induce progressive palatal fibrosis, accompanied by medial traction of the posterior tonsillar pillars ie., scar tissue reduces the airspace in the pharynx leading to velopharyngeal insufficiency. The scar tissue can also make the airway more prone to collapse during sleep.
Despite these adverse results, LAUP continues to be administered by a minority of surgeons. To this day, few if any patients who have undergone laser-assisted uvulopalatopharyngoplasty for primary (social) snoring have been provided with pre- and postoperative polysomnogram (sleep testing) or followup. An LAUP procedure typically costs between two and three thousand American dollars. It takes roughly thirty minutes and is usually done in a surgeon's office as an outpatient procedure. Typically a CO2 type laser is used.
