Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

Abstract

Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea–hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery.

Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients

“…Different oxidative stress pathways can influence the production of NO, such as the synthesis of peroxynitrite by interaction with superoxide or the action of dimethylarginine (ADMA). It interferes with the formation of NO at high levels, the activity of the enzyme dimethylarginine dimethylaminohydrolase is reduced, leading to higher ADMA levels [ 13 , 92 , 93 ].…”

“…As described by several authors, OSAS is associated with an increased incidence of cardiovascular diseases such as high blood pressure, ischemic heart disease, arrhythmias, and cerebrovascular problems. Its treatment with increasingly innovative methods provides promising results on reducing associated comorbidities but Continuous Positive Airway Pressure (CPAP) therapy remains a fundamental approach [ 8 , 9 , 10 , 11 , 12 , 13 ].…”

Current challenges in the diagnosis and treatment of obstructive sleep apnea syndrome in the elderly

“…Using a "barbed" suture, the palatopharyngeal muscle is relocated into a more lateral and anterior position in order to enlarge and stabilize the velopharyngeal region. Good outcomes in terms of AHI reduction and less frequent postoperative complications after barbed repositioning pharyngoplasty for OSA was reported in a recent study by Iannella et al 41 However, surgery should be carefully evaluated in elderly patients with OSA; anesthesiological risks, possible surgical complications, and the risk of surgical failure should be considered before choosing this treatment option. [1][2][3][4][5] In this context, in a recent observational study, Gouveia et al 10 analyzed surgical complications in 107 patients with OSAS older than 65 years of age and showed that elderly patients undergoing sleep surgery had an increased risk of postoperative complications compared with younger people treated with the same procedures.…”

Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients

“…Of the different lateral pharyngoplasty techniques used, barbed reposition pharyngoplasty (BRP) has recently become one of the most practiced palatal surgery techniques in different countries 97 : performed with barbed suture, i.e. knotless bidirectional resorbable suture, it allows obtaining suspension of the palatopharyngeal muscle to stable structures such as the pterygomandibular raphe, with consequent expansion of the lateral walls of the oropharynx without tissue resection of the soft palate region.…”