Impact of Human Papillomavirus Infection on the Outcomes of Uvulopalatopharyngoplasty in Patients with Obstructive Sleep Apnea

Introduction: Obstructive sleep apnea (OSA) is a prevalent respiratory disorder associated with severe comorbidities. While CPAP is the gold standard, surgical alternatives like uvulopalatopharyngoplasty (UPPP) are crucial for non-compliant patients. However, recurrence rates remain high. Recent data suggests a role of viral infections in upper airway pathology. This study aimed to determine the influence of human papillomavirus (HPV) infection on the efficacy of UPPP by analyzing immediate and long-term outcomes in patients with and without HPV infection.Materials and methods: A prospective cohort study was conducted between January 2022 and December 2023. Forty-eight patients with moderate OSA underwent UPPP. Patients were divided into HPV-positive (n=16) and HPV-negative (n=32) groups based on PCR analysis of soft palate biopsies. Outcomes included Apnea-Hypopnea Index (AHI) dynamics, pain intensity (VAS), scarring, and recurrence rates over a 12-month follow-up.Results: Baseline characteristics were similar between groups. Postoperative pain intensity did not differ significantly. Both groups showed significant AHI reduction at 30 days (p<0.001). At 12 months, HPV-positive patients showed a trend toward higher AHI variability. Excessive scarring occurred in 31.2% of HPV-positive vs. 12.5% of HPV-negative patients (p=0.239). Recurrence rates were 31.2% vs. 12.5%, respectively. Recurrence-free survival at 12 months was 68.75% for the HPV-positive group and 87.50% for the HPV-negative group (p=0.129).Discussion: HPV infection does not affect the immediate postoperative course or early respiratory improvements following UPPP. However, long-term follow-up indicates a non-statistically significant tendency toward increased scarring and disease recurrence in HPV-positive patients. These findings suggest a potential negative impact of HPV on long-term surgical efficacy, warranting further investigation with larger cohorts.