1228 The Impact of Modified Uvulopalatopharyngoplasty as a Bridge to Hypoglossal Nerve Stimulation Eligibility

Introduction Severe Obstructive Sleep Apnea (OSA) presents a significant challenge, particularly in cases where patients exhibit intolerance to conventional treatments like Continuous Positive Airway Pressure (CPAP). When the Apnea-Hypopnea Index (AHI) remains markedly high, individuals often seek advanced interventions, such as Hypoglossal Nerve Stimulation (HGNS). However, some individuals face elevated AHI scores that surpass the threshold for qualification for HGNS. This narrative documents a patient's journey through a series of interventions, starting from failed CPAP therapy to undergoing Modified Uvulopalatopharyngoplasty (UPPP), which played a pivotal role in reducing their AHI. Subsequently, the placement of an HGNS implant led to the resolution of their OSA. Report of case(s) Our patient, a 65-year-old man battling severe OSA, experienced CPAP intolerance with an initial AHI of 88. Despite weight loss, his AHI remained above the acceptable range (15-65) for HGNS. Seeking alternatives, the patient underwent a transformative Modified UPPP, resulting in a significant reduction of his AHI. This improvement enabled his eligibility for HGNS. Post-implantation, marked improvements ensued: cessation of snoring, enhanced sleep quality, and substantial overall well-being. Despite transient swallowing difficulties post-surgery, the patient’s overall course was without complications and largely successful. His journey highlights UPPP’s pivotal role in lowering AHI to qualify patients for advanced therapies, suggesting a promising strategy for managing severe OSA in individuals with refractory AHI levels. Conclusion In conclusion, our patient's journey showcases the transformative impact of Modified UPPP, not only in reducing AHI and enabling eligibility for HGNS but also in revealing a pathway for tailored interventions in severe OSA cases. This emphasizes the importance of personalized treatment strategies, and prompts consideration for the integration of multi-tiered interventions in managing complex cases of OSA. Support (if any)