Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique.

INTRODUCTION AND OBJECTIVES: Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success. MATERIAL AND METHODS: Retrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure. RESULTS: Most patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding. CONCLUSIONS: In our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients.

Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique

Introduction and objectives: Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success.Material and methodsRetrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure.ResultsMost patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding.ConclusionsIn our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients. (AU)

Introducción y objetivos: La apnea obstructiva del sueño es el trastorno del sueño más frecuente en todo el mundo, con una incidencia creciente. La faringoplastia es una alternativa de tratamiento en pacientes no aptos para dispositivos de presión positiva continua en la vía aérea (CPAP). El objetivo de este estudio es comparar diferentes técnicas quirúrgicas de faringoplastia para el tratamiento de la apnea obstructiva del sueño y evaluar su influencia en el éxito quirúrgico.Material y métodosEstudio retrospectivo de 92 pacientes que fueron sometidos a faringoplastia para el tratamiento de la apnea obstructiva del sueño desde 2001 hasta 2020. Los pacientes incluidos se sometieron a uvulopalatoplastia clásica (UPPP), uvulopalatoplastia asistida por radiofrecuencia (RF-UPPP) o faringoplastia de reposición con sutura barbada (BRP). Se definió el éxito quirúrgico y se evaluaron los resultados y las complicaciones de cada procedimiento.ResultadosLa mayoría de los pacientes fueron varones, con una edad media de 49,36±9,6 años y un índice de apnea-hipopnea (IAH) medio de 29,14±2,94 eventos/hora. Treinta y seis pacientes realizaron UPPP clásica, 31 se sometieron a RF-UPPP y los 25 restantes realizaron BRP. La BRP obtuvo la mayor tasa de éxito (66%) en comparación con la UPPP (57%) y la RF-UPPP (54%) (p=0,032). La reducción relativa media del IAH tras la cirugía no fue estadísticamente diferente entre los 3 procedimientos (p=0,098), aunque hubo una tendencia a una mayor reducción con la BRP. La mayoría de los síntomas mejoraron tras la cirugía y el ronquido fue el síntoma más recurrente. La BRP tuvo menos sensación de cuerpo extraño después de la cirugía, sin embargo, fue el procedimiento con mayor tasa de hemorragia postoperatoria. (AU)