Uvulopalatopharyngoplasty and barbed reposition pharyngoplasty with and without hyoid suspension for obstructive sleep apnea hypopnea syndrome: A comparison of long-term functional results

Abstract

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common condition; when conservative approaches are not effective, surgical techniques aimed at reducing the airway obstruction effect are used. This retrospective study aimed at comparing the functional outcomes in patients with OSAHS undergoing uvulopalatopharyngoplasty (UPPP) according to Fairbanks and barbed reposition pharyngoplasty (BRP) according to Mantovani, with or without hyoid suspension (HS). One-hundred twenty-two consecutive OSAHS patients who underwent surgical treatment were included in the study. Patients were divided into 4 groups; all patients underwent preoperative and postoperative polysomnography (PSG) with apnea/hypopnea index (AHI) and oxygen desaturation index (ODI) evaluation, and Epworth Sleepiness Scale (ESS) evaluation. The results were analyzed according to the different surgical procedures, in relation to the preoperative PSG and anthropometric data. A significant reduction was observed at 18-month follow-up for patients in BRP group for BMI (p = 0.004), ESS (p < 0.0001), ODI (p < 0.0001), and AHI (p < 0.0001). Risk factors for poor postoperative AHI reduction were evaluated; preoperative AHI was the strongest independent protective factor, while preoperative ODI was the strongest risk factor. The association of HS with UPPP or BRP showed significant results in terms of higher postoperative AHI reduction only when associated to UPPP (p < 0.0001). This study showed that the BRP technique was more effective compared to UPPP for patients with OSAHS. The association of HS showed greater benefits in UPPP compared to BRP. Randomized prospective trials with longer follow-up are necessary to confirm our results and formulate a more accurate indication of the optimal therapeutic strategy.

International Consensus Statement on Obstructive Sleep Apnea

“…showed MLS reduced AHI (47.9–20.8) significantly more than ongoing medical management (45.3–34.5), with more patients (26% vs. 8%) in the surgical arm achieving an AHI <10 1919 . That said, additional levels of surgery do not always yield further AHI reductions 2032 …”

“…1919 That said, additional levels of surgery do not always yield further AHI reductions. 2032 It is prudent to be mindful that initial efficacy may decrease with time due to tissue laxity and non-anatomical factors. The surgical response of UPPP decreased from 67.3% in the short-term to 44.35% after at least 34 months.…”

Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review

“…Table 1 provides a synthesis of the main features of the studies included ( Table 1 ). The majority of included studies were retrospective [ 14 , 15 , 16 , 17 , 18 , 19 ], while two of them were prospective [ 20 , 21 ]. The sample size of each study exhibited variability, with the number of subjects ranging from 20 [ 14 ] to 122 [ 18 ].…”

“…The majority of included studies were retrospective [ 14 , 15 , 16 , 17 , 18 , 19 ], while two of them were prospective [ 20 , 21 ]. The sample size of each study exhibited variability, with the number of subjects ranging from 20 [ 14 ] to 122 [ 18 ]. The total count of patients who underwent velopharyngeal surgery across all studies was 614, for which uvulopalatopharyngoplasty (UPP) and variations in the technique (m-UPP, RF-UPP) were described and performed in four studies (209 patients), anterior palatoplasty (AP) in two studies (52 patients), uvulopalatoflap placement in one study (23 patients), and lateral pharyngoplasty (LP/CLP) in two studies (41 patients).…”

Comparative study between single-stage multilevel surgery and staged surgery for management of snoring and/or obstructive sleep apnea

“…Compared to other techniques, BRP guarantees a more significant and stable retraction of the pharyngeal soft tissue due to the latero-lateral traction and the anchorage to the pterygomandibular raphe, an enlargement of the anteroposterior space, and better preservation of the mucosa and muscle tissue [27]. In addition, the minimal muscle and mucosa resection and the absence of knots in the pharynx are well accepted by the patients in terms of invasiveness [6].…”