Laser Assisted Uvulopalatoplasty (LAUP)
Laser-assisted uvulopalatoplasty (LAUP) is an outpatient procedure proposed as a treatment for snoring with or without associated obstructive sleep apnea. The procedure sequentially reshapes superficial palatal tissue using a carbon dioxide laser. LAUP differs from standard uvulopalatopharyngoplasty (UPPP) since only part of the uvula and associated soft-palate tissues are reshaped. LAUP does not remove or alter tonsils or lateral pharyngeal wall tissue. LAUP is performed in 3 – 7 sessions at 3 - 4 week intervals. One purported advantage of LAUP is that the amount of tissue ablated can be titrated so treatment can be discontinued once snoring is eliminated.
LAUP cannot be considered an equivalent procedure to UPPP. LAUP also differs from radiofrequency ablation of the soft palate although the concept is similar.
Laser-assisted uvulopalatoplasty (LAUP) for the treatment of obstructive sleep apnea syndrome is considered investigational.
Laser-assisted uvulopalatoplasty (LAUP) for the treatment of socially disruptive snoring alone is considered not medically necessary.
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Minimally invasive surgical procedures such as LAUP have limited efficacy in individuals with mild-to-moderate OSA and have not been shown to improve excessive daytime sleepiness in adults. Additional studies are needed.
American Academy of Otolaryngology – Head and Neck Surgery. (2014). Position statement: surgical management of obstructive sleep apnea. Retrieved July 21, 2017 from http://www.entnet.org/content/surgical-management-obstructive-sleep-apnea.
American Academy of Sleep Medicine (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Retrieved July 21, 2017 from http://www.aasmnet.org/Resources/PracticeParameters/PP_SurgicalModificationsOSA.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2016). Surgical treatment of snoring and obstructive sleep apnea syndrome. (7.01.101). Retrieved July 21, 2017 from BlueWeb. (31 articles and/or guidelines reviewed)
Camacho, M., Nesbitt, B., Lambert, E., Song, S., Chang, E., Liu, S., et al. (2017). Laser-assisted uvulopalatoplasty for obstructive sleep apnea: a systematic review and meta-analysis. Sleep, 40 (3), 1-8. (Level 1 evidence)
Göktas,Ö., Solmaz, M., Göktas, G., & Olze, H. (2014). Long-term results in obstructive sleep apnea syndrome (OSAS) after laser-assisted uvulopalatoplasty (LAUP). PLOS One, 9 (6), e100211. (Level 4 evidence)
Wisconsin Physician Services Insurance Corporation (2017, January) Local Coverage Determination (LCD) for surgical treatment of obstructive sleep apnea (OSA) (L34526). Retrieved July 21, 2017 from https://www.cms.gov.
ORIGINAL EFFECTIVE DATE: 3/1985
MOST RECENT REVIEW DATE: 8/10/2017
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