Management Concentric Collapse of Velopharynx in Obstructive Sleep Apnoea Using a Modified Barbed Palato-Pharyngoplasty Technique

Abstract

Background: Multilevel surgical techniques are important in the treatment of obstructive sleep apnoea especially when the patient is non-compliant to Continuous Positive Airway Pressure therapy (CPAP). A modified pharyngoplasty technique is described in OSA patients where the major cause of upper airway obstruction was due to concentric collapse of velopharynx. Methods: Twenty four patients with evidence of OSA on polysomnography were included. In all patients the major cause of obstruction was due to concentric collapse of velopharynx as evidenced on Muller Maneuver (MM) and Drug Induced Sleep Endoscopy (DISE). All had non-adherence to (CPAP) therapy and underwent Barbed Palato Pharyngoplasty (BPP) for correction of concentric collapse of velum. Apnoea-Hypopnoea Index (AHI), Lowest Oxygen Saturation (L-sat), Epworth Sleepiness Score (ESS), Visual Analog Score (VAS) for snoring were assessed both pre-operatively and six months post-operatively. All patients underwent awake flexible nasopharyngoscopy with MM to assess the site and score the severity of obstruction before and six months after surgery. Results: Post-operative flexible nasopharyngoscopy with Muller Maneuver revealed absence of collapse of velum in eleven patients, 25% collapse in 10 and 50% collapse in 3 patients. Post-operatively, significant reduction of mean values were observed in AHI, ESS, VAS for snoring from 32.04 to 15.27, 12.75 to 4.54 and from 7.17 to 2.54 respectively. The mean L-sat improved from 74.44 to 86.04. There were no major surgical complications. Conclusion: BPP is a minimally invasive knotless technique and is best suited in OSA, where the major obstruction is due to concentric collapse of the velum.