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Indications for and Outcomes of Expansion Sphincter Pharyngoplasty to Treat Lateral Pharyngeal Collapse in Patients With Obstructive Sleep Apnea
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date:2019.06.10author:
Original Investigation
March 7, 2019

Indications for and Outcomes of Expansion Sphincter Pharyngoplasty to Treat Lateral Pharyngeal Collapse in Patients With Obstructive Sleep Apnea

JAMA Otolaryngol Head Neck Surg. 2019;145(5):405-412. doi:10.1001/jamaoto.2019.0006
 

Key Points

Question  Is expansion sphincter pharyngoplasty an effective surgical technique to widen the lateral pharyngeal walls of patients with obstructive sleep apnea, and which patients are likely to benefit most from this surgery?

Findings  In this cohort study of 63 Korean patients who had confirmed moderate or severe obstructive sleep apnea with lateral pharyngeal wall collapse, correction of the collapse by means of expansion sphincter pharyngoplasty was associated with a successful outcome in 67% of the patients, and their objective measures of sleep quality were significantly improved.

Meaning

Expansion sphincter pharyngoplasty may reduce lateral pharyngeal collapse in patients with moderate or severe obstructive sleep apnea and palatal circumferential narrowing with bulky lateral pharyngeal tissue.

 

Abstract

Importance  The lateral pharyngeal wall is recognized as an important site of upper airway collapse during sleep in patients with obstructive sleep apnea (OSA), and expansion sphincter pharyngoplasty (ESP) may have promising clinical utility in patients with OSA and lateral pharyngeal wall collapse.

 

Objectives  To evaluate the therapeutic outcomes of ESP in conjunction with other surgical procedures and to investigate indications for ESP in patients with OSA.

 

Design, Setting, and Participants  Cohort study of 63 patients with OSA diagnosed with lateral pharyngeal collapse under drug-induced sleep endoscopy who underwent ESP combined with tonsillectomy, uvuloplasty, or nasal surgery at Seoul National University Hospital in Seoul, Korea, between March 1, 2015, and December 1, 2016.

 

Main Outcomes and Measures  The primary outcome measure was the change in the apnea-hypopnea index (AHI) after surgery (AHI represents the number of apnea-hypopnea events per hour). Other outcome measures were differences in the surgical response rates, lowest oxygen saturation, subjective visual analog scale scores for snoring and apnea, and Epworth Sleepiness Scale score.

 

Results  Fifty of the 63 patients (79%) were male; the mean age was 42.1 (range, 20-54) years, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.6 (range, 19.0-32.1). Expansion sphincter pharyngoplasty was performed in patients with OSA with an AHI greater than 15 events per hour, more than 75% retropalatal circumferential narrowing when awake, and narrowed oropharynx due to bulky soft tissue around the lateral pharyngeal wall. In 42 of the 63 patients (67%), ESP was objectively successful in correcting lateral pharyngeal collapse; there was a significant reduction in mean AHI from 35.5 to 17.3 (mean difference, 18.1; 95% CI, 16.3-20.0) and improvement of the lowest mean (SD) oxygen saturation measurement from 78.2% (21.3%) to 86.4% (10.6%) (mean difference, 8.60%; 95% CI, 6.60%-10.60%) 6 months after the operation. The rate of postoperative complications, including pain and bleeding, was minimal after ESP, and a few patients reported an abnormal sensation around the soft palate and swallowing difficulty after ESP.

 

Conclusions and Relevance  Expansion sphincter pharyngoplasty appears to be a promising surgical technique to reduce lateral pharyngeal collapse in patients with moderate or severe OSA. Clinical data suggest that both severe palatal circumferential narrowing and bulky lateral pharyngeal tissue are favorable surgical indications for ESP in patients with OSA.

 

 

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https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2726817