Anterior Palatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta‐analysis

Bınar, Murat; Karakoç, Ömer

doi:10.1177/0194599817739857

Cited by 18 publications

(14 citation statements)

References 20 publications

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“…There was a reduction in the AHI greater than 50% in 63.2% of cases, a success rate higher than that previously reported with the use of anterior pharyngoplasty alone. 13 Also, there was a reduction in the AHI of less than 50% in 21% of cases, and an increase in the AHI in 15.8% of cases. In this respect, failure of the proposed surgical treatment could not be explained by the baseline BMI, weight gain during follow-up, or increased severity of symptoms or OSAS postoperatively.…”

Section: Discussionmentioning

confidence: 83%

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Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

Pinto

Godoy

Nunes

et al. 2019

Int Arch Otorhinolaryngol

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Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively ( p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

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Section: Discussionmentioning

confidence: 83%

“…1 9 A recent meta-analysis of anterior pharyngoplasty showed success in only 60.6% of patients, indicating the need for surgical procedures involving the lateral wall to improve the surgical outcome of patients with OSAS. 13…”

Section: Discussionmentioning

confidence: 99%

Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

Pinto

Godoy

Nunes

et al. 2019

Int Arch Otorhinolaryngol

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“…There was only one positive cohort of single-center RCT designs for UPPP, which reported a decrease in AHI from 53.3 to 21.1 after the 6-month evaluation (52.6 to 46.8 in control) while having no side effects. In the UPPP metaanalysis including this, it was reported that the severity of AHI significantly improved from 35.66 to 13.91, with subjective sleepiness improving from 11.65 to 5.08 after 8 months in selected patients [129][130][131][132][133].…”

Section: Remarks a Reports On The Effect Of Each Surgerymentioning

confidence: 85%

Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020

Akashiba

Inoue

Uchimura

et al. 2022

Sleep Biol. Rhythms

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The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the “Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults” was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the “Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension” Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.

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“…10 ESP was defined as sufficient surgical options for both LPC and repeated in different studies in the recent literature. 3,6,7,[11][12][13] Pang et al 8 reported results of 73 patients with diagnosed combined LPC or CPC and underwent APwESP surgery. They included 20 patients with mild OSA, 33 patients with moderate OSA, and 20 severe OSA patients.…”

Section: Discussionmentioning

confidence: 99%

“…6 Binar et al reported the success of the AP technique as 60.6% in the metaanalysis published in 2018. 7 Thereafter, Pang et al used these two techniques together for the treatment of concentric velopharyngeal collapse in a study group participated with mild, moderate, and severe OSA patients and they found a 67% and above surgical success. 8 A recent meta-analysis of 17 years showed that the best apnea-hypopnea index (AHI) reduction was obtained with the AP, (mean 24.7, range 20.7-28.6) followed by the lateral/expansion pharyngoplasty procedures (mean 19.8, range 16.9-22.6), and the least with the classical uvulopalatopharyngoplasty (UPPP), (mean 17.2, range 12.6-21.8).…”

Section: Introductionmentioning

confidence: 99%

Anterior Palatoplasty With Expansion Sphincter Pharyngoplasty for All Type of Pharyngeal Collapse

Ciğer

İşlek

2021

The Laryngoscope

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Objectives/Hypothesis: This study was aimed to compare the efficiency of the anterior palatoplasty and expansion sphincter pharyngoplasty (APwESP) technique for all patterns of velopharyngeal obstruction (anterior-posterior [APPC], lateral [LPC], or combined circular pharyngeal collapse [CPC]).Study Design: The study was designed as a randomized prospective trial at Kâtip Çelebi University, Atatürk Training, and Research Hospital.Methods: Patients only with velopharyngeal obstruction were included. Three groups were created according to the obstruction pattern (APPC, LPC, and CPC) for the study. Outcome parameters included patient's demographics, apnea-hypopnea index (AHI), lowest oxygen saturation (LOS), Stanford subjective scale of snoring (SSSS), and Epworth sleepiness scale (ESS).Results: Thirty-one (34.1%) patients were in APPC group, while 30 (33.0%) patients were in LPC, and 30 (33.0%) were in CPC group. Preoperatively for all patients, on average, AHI was 33.4 AE 13.6, SSSS was 8.3 AE 1.0, ESS was 16.5 AE 2.6, and LOS was determined as 85.5 AE 3.6. There was a significant postoperative improvement in all parameters for all patients. There was no significant difference in outcome parameters between the groups according to obstruction pattern postoperatively. After APwESP surgery, obstruction pattern was not a significant factor for AHI (P = .234), SSSS (P = .180), and LOS (P = .280) (repeated measure analysis of variance test). The rate of surgical success was detected similarly for both of the study groups (P = .435). The rate of successful surgery for severe obstructive sleep apnea in the APPC group was 72.2%, 88.2% in the LPC group, and 75.0% in the CPC group (P = .472).Conclusion: A combination of APwESP surgery can manage all types of pharyngeal obstruction confidently.

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Anterior Palatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta‐analysis

Cited by 18 publications

References 20 publications

Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020

Anterior Palatoplasty With Expansion Sphincter Pharyngoplasty for All Type of Pharyngeal Collapse

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