Download PDF
CC BY 4.0 · Int Arch Otorhinolaryngol 2024; 28(04): e574-e578
DOI: 10.1055/s-0044-1782630
Original Research

Efficacy of Expansion Pharyngoplasty without Drug-induced Sleep Endoscopy Screening in Obstructive Sleep Apnea

Rafael Tenor 
1   Department of Otolaryngology, Head and Neck Surgery, Hospital Universitario Costa del Sol, Marbella, Spain
2   Department of Radiology and Physical Medicine, Ophthalmology and Otorhinolaryngology, Faculty of Medicine, University of Málaga, Spain
,
Juan Miguel Palomeque-Vera
1   Department of Otolaryngology, Head and Neck Surgery, Hospital Universitario Costa del Sol, Marbella, Spain
,
Angel Bandera-López 
1   Department of Otolaryngology, Head and Neck Surgery, Hospital Universitario Costa del Sol, Marbella, Spain
,
Pilar Cuellar
3   Department of Pneumology, Hospital Universitario Costa del Sol, Marbella, Spain
,
Manuel Oliva-Domínguez
1   Department of Otolaryngology, Head and Neck Surgery, Hospital Universitario Costa del Sol, Marbella, Spain
› Author Affiliations Funding This has authors declare that they have not received funding from agencies in the public, private, or non-profit sectors for the conduction of the present study.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Expansion sphincter pharyngoplasty has been shown to be a good alternative to continuous pressure devices in patients with moderate to severe obstructive sleep apnea. On the other hand, drug-induced sleep endoscopy provides information on the pattern of collapse in obstructive sleep apnea, although it is unclear whether this information improves the surgical outcomes.

Objective To evaluate the success rate obtained when performing expansion sphincter pharyngoplasty on a group of patients diagnosed with moderate to severe obstructive sleep apnea who were not previously selected by drug-induced sleep endoscopy.

Methods We present a series of patients with moderate to severe obstructive sleep apnea who underwent surgery. Pre- and postoperative home sleep apnea tests were performed. The success rate was calculated, and we assessed whether there were statistically significant pre- and postoperative differences in the apnea-hypopnea index and oximetry values.

Results In total, 20 patients were included, and the surgical success rate was of 80%. Statistically significant improvements were demonstrated in the mean apnea-hypopnea index (from 40.25 ± 15.18 events/hour to 13.14 ± 13.82 events/hour; p < 0. 0001), the mean oximetric data (from 26.3 ± 12.97 desaturations/hour to 13.57 ± 15.02 desaturations/hour; p = 0.034), and in the mean percentage of total sleep time in which the patient had less than 90% of saturation (from 8.64 ± 9.25% to 4.4 ± 7.76%; p = 0.028).

Conclusion The results showed significant improvements in the apnea-hypopnea index and in the oximetric data, with a surgical success rate of 80%, despite the lack of prior drug-induced sleep endoscopy screening.

Keywords

sleep apnea - surgical procedures - endoscopy


Publication History

Received: 18 September 2023

Accepted: 18 February 2024

Article published online:
25 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 de Araujo Dantas AB, Gonçalves FM, Martins AA. et al. Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression. Sleep Breath 2023; 27 (06) 2083-2109
    CrossrefPubMedSearch in Google Scholar
  • 2 Mediano O, González Mangado N, Montserrat JM. et al; el Spanish Sleep Network. Documento internacional de consenso sobre apnea obstructiva del sueño. Arch Bronconeumol 2022; 58 (01) 52-68
    CrossrefPubMedSearch in Google Scholar
  • 3 Hong SN, Kim HG, Han SY. et al. 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 (05) 405-412
    CrossrefPubMedSearch in Google Scholar
  • 4 Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 2007; 137 (01) 110-114
    CrossrefPubMedSearch in Google Scholar
  • 5 Sorrenti G, Piccin O. Functional expansion pharyngoplasty in the treatment of obstructive sleep apnea. Laryngoscope 2013; 123 (11) 2905-2908
    CrossrefPubMedSearch in Google Scholar
  • 6 Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 2004; 114 (03) 454-459
    CrossrefPubMedSearch in Google Scholar
  • 7 Friedman M, Wilson M. Re-redefining success in airway surgery for obstructive sleep apnea. Sleep 2009; 32 (01) 17
    CrossrefSearch in Google Scholar
  • 8 Elshaug AG, Moss JR, Southcott AM, Hiller JE. Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep 2007; 30 (04) 461-467
    CrossrefPubMedSearch in Google Scholar
  • 9 Carrasco-Llatas M, Marcano-Acuña M, Zerpa-Zerpa V, Dalmau-Galofre J. Surgical results of different palate techniques to treat oropharyngeal collapse. Eur Arch Otorhinolaryngol 2015; 272 (09) 2535-2540
    CrossrefPubMedSearch in Google Scholar
  • 10 Pang KP, Piccin O, Pang EB, Pang KA, Chan YH, Rotenberg BW. Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA. Indian J Otolaryngol Head Neck Surg 2016; 68 (04) 528-533
    CrossrefPubMedSearch in Google Scholar
  • 11 Güler İ, Kuzucu İ, Baklacı D, Kum RO, Kum NY, Özcan M. Efficiency of Expansion Sphincter Pharyngoplasty in the Treatment of Obstructive Sleep Apnea Syndrome. Turk Arch Otorhinolaryngol 2018; 56 (04) 206-209
    CrossrefPubMedSearch in Google Scholar
  • 12 Bosco G, Pérez-Martín N, Racionero MA, Plaza G. Expansion sphincter pharyngoplasty: Usefulness of DISE. Acta Otorrinolaringol Esp (Engl Ed) 2019; 70 (04) 215-221
    CrossrefPubMedSearch in Google Scholar
  • 13 Lorusso F, Dispenza F, Modica DM, Gallina S. The role of modified expansion sphincter pharyngoplasty in multilevel obstructive sleep apnea syndrome surgery. Int Arch Otorhinolaryngol 2018; 22 (04) 432-436
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Cayir S, Yesildag K, Kayabasi S. Long-term efficacy of expansion sphincter pharyngoplasty in obstructive sleep apnea syndrome. Sleep Breath 2021; 25 (04) 1913-1918
    CrossrefPubMedSearch in Google Scholar
  • 15 Ciğer E, İşlek A. Anterior Palatoplasty With Expansion Sphincter Pharyngoplasty for All Type of Pharyngeal Collapse. Laryngoscope 2022; 132 (06) 1313-1319
    CrossrefPubMedSearch in Google Scholar
  • 16 Lorusso F, Dispenza F, Sireci F, Immordino A, Immordino P, Gallina S. Management of pharyngeal collapse in patients affected by moderate obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital 2022; 42 (03) 273-280
    CrossrefPubMedSearch in Google Scholar
  • 17 De Vito A, Carrasco Llatas M, Ravesloot MJ. et al. European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 2018; 43 (06) 1541-1552
    CrossrefPubMedSearch in Google Scholar
  • 18 Lee EJ, Cho JH. Meta-Analysis of Obstruction Site Observed With Drug-Induced Sleep Endoscopy in Patients With Obstructive Sleep Apnea. Laryngoscope 2019; 129 (05) 1235-1243
    CrossrefPubMedSearch in Google Scholar
  • 19 Lisan Q, Baudouin R, Lechien JR, Hans S, Blumen M. Is drug-induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta-analysis. Clin Otolaryngol 2023; 48 (02) 122-129
    CrossrefPubMedSearch in Google Scholar
  • 20 Pang KP, Baptista PM, Olszewska E. et al. Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients. Laryngoscope 2020; 130 (02) 551-555
    CrossrefPubMedSearch in Google Scholar
  • 21 Hsu YS, Jacobowitz O. Does sleep endoscopy staging pattern correlate with outcome of advanced palatopharyngoplasty for moderate to severe obstructive sleep apnea?. J Clin Sleep Med 2017; 13 (10) 1137-1144
    CrossrefPubMedSearch in Google Scholar
  • 22 Iannella G, Magliulo G, Cammaroto G. et al. Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial. Sleep Breath 2022; 26 (04) 1621-1632
    CrossrefPubMedSearch in Google Scholar