Managing obstructive sleep apnea patients with CPAP failure with a novel Lateral Pharyngoplasty as a stand-alone procedure

Elzayat, Saad; El-Sobki, Ahmed; El-Deeb, Mohamed E; Moussa, Hany H.

doi:10.1016/j.amjoto.2020.102500

Cited by 11 publications

(16 citation statements)

References 20 publications

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“…The reported success rate with LP varies widely from 50% to 100% with consistent decrease in AHI across the studies. By performing the most recent version of LP, Elzayat et al 1715 reported a 70% success rate in a series of non-selected patients. These authors did DISE preoperatively (not for the purpose of selecting the procedure) and repeated DISE in surgical failures and found that, by excluding patients with complete hypopharyngeal collapse on DISE, LP improves 75% of patients with OSA with a success rate of 90%.…”

Section: Ixd4cmentioning

confidence: 99%

“…These authors did DISE preoperatively (not for the purpose of selecting the procedure) and repeated DISE in surgical failures and found that, by excluding patients with complete hypopharyngeal collapse on DISE, LP improves 75% of patients with OSA with a success rate of 90%. 1715 Bleeding and swallowing function are important considerations when performing any palatopharyngoplasty. Only one study reported two cases of postoperative bleeding after LP, which did not require return to the operating room.…”

Section: Ixd4cmentioning

confidence: 99%

Section: Surgical Treatment For Osamentioning

confidence: 99%

“…reported a 70% success rate in a series of non‐selected patients. These authors did DISE preoperatively (not for the purpose of selecting the procedure) and repeated DISE in surgical failures and found that, by excluding patients with complete hypopharyngeal collapse on DISE, LP improves 75% of patients with OSA with a success rate of 90% 1715 …”

Section: Surgical Treatment For Osamentioning

confidence: 99%

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Section: Ixd4cmentioning

confidence: 99%

Section: Ixd4cmentioning

confidence: 99%

Section: Surgical Treatment For Osamentioning

confidence: 99%

Section: Surgical Treatment For Osamentioning

confidence: 99%

See 2 more Smart Citations

International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

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“…16 However, the effects of these surgical procedures on the staging or pattern of upper airway obstruction identified in drug-induced sleep endoscopy (DISE) have not been well investigated. 17 To target the sites and structures of upper airway obstruction before surgery, sleep endoscopy was first advocated by Croft and Pringle in the 1990s. 18 Kezirian renamed this technique "DISE" 19 and developed the velum, oropharyngeal lateral walls, tongue base, and epiglottis (VOTE) classification system.…”

Section: Introductionmentioning

confidence: 99%

Post-Operative Sleep Endoscopy with Target-Controlled Infusion After Palatopharyngoplasty for Obstructive Sleep Apnea: Anatomical and Polysomnographic Outcomes

Chiu¹,

Chang²,

Liao³

et al. 2021

NSS

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Introduction:The findings of drug-induced sleep endoscopy (DISE) are not always correlated with the outcome of upper airway surgery for obstructive sleep apnea (OSA), and whether multilevel surgery is truly required in treating multilevel obstruction identified in preoperative DISE remains an issue. We attempted to compare DISE findings before and after palatopharyngoplasty in patients with OSA because changes in DISE may be beneficial to better understand polysomnographic and anatomical outcomes. Methods: This was a prospective cohort study for 34 patients with moderate to severe OSA who underwent palatopharyngoplasty at a tertiary care center from 2016 to 2018. We recorded the patients' demographic characteristics, procedures, and surgical outcomes and compared the preoperative and postoperative DISE staging patterns. Results: The apnea-hypopnea index (AHI) values of 34 adults improved significantly after surgery (40.6 ± 23.3 versus 25.6 ± 20.6, P < 0.001). The majority of patients, 26/34, had preoperative complete concentric collapse at the velum, and for most (20/26, 77%) there was a change of the collapse pattern into anteroposterior collapse postoperatively. Patients with postoperative velar collapse had higher follow-up AHI values than those who without (27.8 ± 21.9 versus 15.2 ± 7.7, P = 0.023). Patients with preoperative complete tongue base collapse had higher follow-up AHI values than did those with no or partial collapse (40.6 ± 21.0 versus 21.0 ± 18.6, P = 0.017). Patients with postoperative complete tongue base collapse also had higher follow-up AHI values than the others (42.7 ± 22.1 versus 18.5 ± 15.4, P = 0.001). Conclusion:Palatopharyngoplasty could change the collapse pattern at the velum in most patients. Preoperative and postoperative complete tongue base collapse and postoperative velar collapse identified in TCI-DISE were associated with relatively poor outcomes.

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