Evolution of soft palate surgery techniques for Obstructive Sleep Apnea patients: A comparative study for single level palatal surgeries

Abstract

Objectives

to compare the results of tissue preservation techniques of soft palate surgeries including expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) for patients suffering from obstructive sleep apnea (OSA) with the traditional uvulopalatopharyngoplasty (UPPP).

Design

interventional comparative study.

Setting

Morgagni- Pierantoni Hospital.

Participants

seventy five patients were included in the study, divided into three groups with 25 patients per group: UPPP, ESP or BRP.

Main outcomes measures

Polysomnography was done for all patients pre- and post-operatively, the post-operative results were recorded at least six months after surgery. All patients were assessed pre-operatively using drug induced sleep endoscopy. Epworth Sleepiness scale and body mass index were registered for all patients before and after surgery.

Results

the mean of pre- and post-operative differences of apnea hypopnea index values were higher in BRP group than ESP: 15.76±14.5 Vs 10.13±5.3; P <0.05 and UPPP groups: 15.76± 14.5 Vs 6.08±5.5; P <0.0005. The mean of differences of oxygen desaturation index values was higher in BRP group than UPPP group: 15.09±17.6 Vs 7.13±6.8; P <0.0005, but not significantly higher than ESP group: 15.09± 17.6 Vs 6.48±7.9; P >0.05. The mean of differences of ESS values was higher in BRP group than ESP group: 5.52 ±4.1 Vs 4.84±3.3; P <0.005 and UPPP groups: 5.52 ±4.1Vs 1.36±1.9; P <0.005. Finally, the pre- and post-operative mean of differences of lowest oxygen saturation values were not statistically significant among the three groups (P >0.05).

Conclusion

BRP can be considered an effective procedure on the basis of the post-operative outcomes. ESP still proves to be a good technique especially when performed by experienced surgeons. Both techniques proved to be superior to UPPP.

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