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Chulalongkorn Medical Journal

Abstract

Background: Surgery is a treatment option for obstructive sleep apnea (OSA) patients for whom positive airway pressure therapy is not chosen. Various palatal surgical techniques have been developed. However, the medical literature has limited accounts concerning the use of combination of these techniques to improved outcomes.

Objective: The aim of this study is to assess the efficacy of a combined anterior palatoplasty (AP) and barbed suspension pharyngoplasty (BSP) in treating adult OSA.

Methods: Data of OSA patients who underwent the combined AP with BSP between July 2020 to May 2024 were retrospectively reviewed. The surgical outcomes, including apnea-hypopnea index (AHI), lowest oxygen saturation (LSAT), snoring scores, and Epworth Sleepiness Scale (ESS), and post-operative complications were collected.

Results: Twenty-four patients were included in our study, with thirteen patients (54.2%) underwent post-operative polysomnography with a mean follow-up time of 5.8 ± 2.2 months. The median (IQ-IIIQ) AHI decreased insignificantly from 27.3 (19.8-53.2) to 20.2 (14.4-37.0) events/h (p = 0.216) post-operatively. The median (IQ-IIIQ) snoring scores significantly improved from 6.0 (4.0-8.0) to 3.0 (0-4.0) (p < 0.001) and ESS decreased from 11.0 (9.2-14.8) to 6.5 (4.0-9.8) (p < 0.001). LSAT did not change in this study. There were no serious post-operative complications.

Conclusion: The combined technique of AP and BSP was safe and significantly improved snoring scores and reduced daytime sleepiness in OSA patients with retropalatal and oropharyngeal obstruction. Improvement in AHI was observed in some patients.

DOI

10.56808/2673-060X.5549

First Page

*Correspondence to: Natamon Charakorn, Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand E-mail: natamonc@gmail.com Obstructive sleep apnea (OSA) is a common sleep-disordered breathing characterized by repetitive narrowing or collapse of upper airway. (1) The disorder is associated with many health problems, including cardiovascular disease, cognitive impairment, a lower quality of life, and increased risk of motor vehicle accidents. The underlying pathophysiology is multifactorial and varies considerably between individuals. (1) Positive airway pressure (PAP) is considered the gold standard treatment for moderate to severe OSA. However, many people are unable to tolerate or accept using the machine, and in such cases, upper airway surgery is an alternative. Various surgical techniques have been proposed for correction of the various collapsible sites, of which new palatal surgical procedures are commonly proposed as the soft palate is the most common site of obstruction. (2, 3) The conventional uvulopalatopharyngoplasty (UPPP) method has reported significant complications, including velopharyngeal incompetence, bleeding, and nasopharyngeal stenosis. Its long-term success rates is less than 50%. (4) Expansion sphincter pharyngoplasty (ESP) is a highly successful technique with minimally invasive approach. (5) The procedure involves repositioning palatopharyngeus muscle to the palatine muscle near the pterygoid hamulus. (6, 7) Currently, there are many palatal surgical techniques aimed at improving surgical outcomes and decreasing complications. (6, 8) Anterior palatoplasty (AP), developed by Pang et al. in 2007, is a modified cautery-assisted palatal stiffening operation (modified CAPSO). This procedure involves removal of the middle part of the soft palate tissue in order to create scarring and stiffen the soft palate. (9) Additionally, a part of the redundant uvula may also be trimmed. Previous reports have shown that this technique effectively reduces apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), snoring sound, and increases lowest oxygen saturation (LSAT) in patients with snoring and mild to moderate OSA. (4, 9-12) Anterior palatoplasty is considered a simple, effective, and inexpensive procedure with minimal complications. (4, 10)

Last Page

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