Speech Status

Sleep apnea, a cessation of breathing for at least 10 s during sleep, has been known to occur over 300 times in one evening, thereby severely affecting daytime functioning. The sleep apnea syndrome results in behavioral manifestations such as excessive daytime sleepiness, memory impairments, depression, and complaints of early morning headaches. Due to these disruptions in daily functioning, intensive study has been given to the elimination of these apneic episodes during sleep.

Several methods for eliminating sleep apnea have been attempted. These involve medical procedures including the administration of drugs, therapeutic procedures such as CPAP (continuous positive airway pressure) and surgical techniques such as tracheos­tomy and UPPP.

Although UPPP surgery has been in use since the early 1980s, it does not appear to be successful in all patients. In fact, it may only provide resolution of the sleep apnea symptoms for as few as 50 percent of the patients whb undergo the surgery. This may be due to the fact that the site of obstruction may have been diagnosed incorrectly or the patient may have multiple sites of obstruction. It appears that this surgery may be performed unnecessarily in some cases, as the sleep apnea symptoms remain unre­solved.
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The UPPP surgical procedure involves removal of 1.0 to 3.0 cm of soft palate tissue with removal of redundant oropharyngeal mucosa and lateral tissue from the anterior and sometimes posterior faucial pillars. This procedure results in a shortened soft palate. In cleft palate children or adults who also have a shortened soft palate due to structural abnormalities, speech problems are known to occur as a result of this palatal inadequacy. It follows that if palatal tissue in this area is purposely removed, as in UPPP, palatal inadequacy leading to defective speech also may occur in the UPPP population.

Because the UPPP surgery is not an absolute cure for sleep apnea and its symptoms, it is important that the individual patient and the sleep disorders team weigh the potential risks and benefits of the surgery. A possible risk following this surgery may be velopha­ryngeal malfunctioning due to the shortened palate. Few researchers have systematically studied the effects of this surgery as it relates to speech production.

Preoperative and postoperative speech recordings of 34 patients following UPPP were completed by Gislason et al. Their findings indicated that signs of nasality were not identified in these patients. They did report some changes in the voice quality of their patients which appeared to be resolved by six months. Of 64 patients evaluated with speech recordings by Poole et al, none was reported to experience speech problems following UPPP Similarly, Dickson and Blokmanis failed to find speech problems postopera­tively in their patients. In an unpublished study by Coleman and Sly, acoustic analysis and listener judgments did not identify a nasal correlate during the speech of their UPPP patients.

It is of importance to note that little information is given regarding the methodologic approach of the studies cited above. Although speech results are reported in these studies, control measures generally are not discussed. Thus, the rigor with which speech parameters were measured is questionable.
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In carefully controlled studies by Monoson and associates, speech problems were identified in apnea patients who had not been treated surgically. These results appear to be in conflict with the more subjective studies cited above in that the latter studies reported no speech problems either before or after surgery. Monoson et al reported that patients with sleep apnea do exhibit speech disorders involving resonance (nasality), articulation, and phonation. More prevalent were the voice disorders (phonation) and the articulation disorders. Twenty of the 27 apnea patients studied were identified as having a speech disorder.

In view of the conflicting reports discussed, there remains some uncertainty about the speech status in patients following the UPPP surgery. The twofold purpose of this study was: 1) to determine if speech quality is altered following the UPPP procedure, and 2) if speech quality is modified, what major factors are related to the change? The study was conducted in three phases: 1) nasal airflow assessment, 2) speech recordings with listener judgments, and 3) question­naire survey.