Long-term changes in subjective daytime sleepiness following tonsillectomy and uvulopalatopharyngoplasty (UPPP)

Diseases of the palatine tonsils may be associated with varying degrees of subjective daytime sleepiness (SDS), a symptom that may affect daily functioning. This study evaluated long-term changes in SDS in patients before and after tonsillectomy or uvulopalatopharyngoplasty (UPPP). The primary aim of this study was to evaluate long-term changes in SDS following tonsillectomy or UPPP. Secondary objectives included the assessment of patient satisfaction and the influence of demographic and clinical factors, including sex, age, chronic diseases, tonsil size, and histopathological findings, on treatment outcomes. A prospective cohort study included 105 adult patients, with an 85% follow-up rate: 89 patients (26 women, 63 men). SDS was assessed using the Epworth Sleepiness Scale before surgery and after a mean follow-up of 6 years. Additional analyses considered demographic and clinical variables. Patient satisfaction was measured using a visual analog scale and willingness to undergo repeat surgery. Both tonsillectomy and UPPP were associated with a significant long-term reduction in SDS. The mean ESS score decreased from 7.29 preoperatively to 4.37 at follow-up ( P < .05). A clinically meaningful improvement in ESS of ≥2 points was achieved in 71.9% of patients, and the proportion of patients with normal ESS scores (≤10) increased from 75.3% to 92.1% ( P < .001). While the unadjusted ESS reduction was greater after UPPP than after tonsillectomy (4.22 vs 1.81 points), multivariable analysis demonstrated a significant interaction between surgical procedure and baseline ESS, indicating that the magnitude of improvement differed between procedures according to baseline subjective sleepiness. Sex, tonsil size, histopathological findings, and chronic diseases did not significantly influence the outcomes. Tonsillectomy and UPPP were associated with a sustained, long-term reduction in SDS. The magnitude of postoperative improvement increased with baseline subjective sleepiness, with the relative difference between procedures becoming greater at higher baseline ESS values. These findings suggest that upper airway surgery may be associated with durable improvements in patient-reported daytime sleepiness, including among patients with baseline ESS scores within the non-EDS range.