One-Stage Multilevel Surgery for Treatment of Obstructive Sleep Apnea Syndrome

Abstract

We report the results of one-stage multilevel upper airway surgery for patients who could not tolerate continuous positive airway pressure (CPAP). Patients treated with multilevel surgery at a University Hospital in 2015–2019 were identified from a prospectively maintained database. The inclusion criteria were aged 18–70 years, body mass index (BMI) < 35 kg/m2, apnea–hypopnea index (AHI) > 20, and lingual tonsil hypertrophy grade 3 or 4. Drug-induced sleep endoscopy was performed before surgery in all patients. Multilevel surgery was performed in one stage and included expansion sphincter pharyngoplasty (ESP), coblation tongue base reduction (CTBR), and partial epiglottectomy (PE) as required. The outcome measures were postoperative AHI, time percentage oxygen saturation < 90%, and Epworth Sleepiness Scale (ESS) score. A total of 24 patients were included: median age 49.1 years, average BMI 27.26 kg/m2, and 90% men. Ten patients received ESP plus CTBR plus PE, eight received ESP plus CTBR, and six received ESP plus PE. The mean preoperative AHI was 33.01 at baseline and improved to 17.7 ± 13 after surgery (p < 0.05). The ESS score decreased from 11 ± 5.11 to 7.9 ± 4.94 (p < 0.05). The surgical success rate according to Sher’s criteria was 82.3%. The median follow-up was 23.3 months (range 12–36). These findings suggest that multilevel surgery is a safe and successful treatment of OSAHS.

Variations in Polysomnographic Indices of Obstructive Sleep Apnea following Lingual Tonsil Hypertrophy Excision: Is the Difference Significant?

“…The results of the current study have been supported by a recent study, which showed a significant statistical decrease in the ESS score from 11 ± 5.11 to 7.9 ± 4.94 ( p < 0.05) after ablation of the lingual tonsils using coblation technology, as part of multilevel surgery performed in a study on 24 patients. This improvement was associated with a significant reduction in the mean AHI from 33.01 ± 17 to 17.7 ± 13 postoperatively ( p < 0.05) [ 15 ]. The difference between the preoperative and postoperative mean ± SD of the snoring index was statistically significant.…”

OSA: Treatments beyond CPAP

“…Continuous Positive Air Pressure (CPAP) is considered the gold standard treatment of this disease, especially in case of moderate to severe OSA [ 1 , 2 , 4 , 5 , 7 ].…”

“…Despite the proven effectiveness of CPAP, a high percentage of patients shows low adherence, with reduced therapeutic efficacy as an effect [ 1 , 2 , 4 , 5 , 7 ].…”

“…Another treatment option for OSA is surgery, which has attracted great scientific interest in recent years [ 2 , 3 , 4 , 5 , 7 , 8 ].…”

“…In the last decades, the use of Trans-Oral Robotic Surgery (TORS) for the treatment of OSA has become increasingly important, with satisfactory results reported also in moderate and severe OSA [ 2 , 4 , 7 , 8 ]. TORS is a minimally invasive approach that allows partial resection of the BOT (including lingual tonsils and, eventually, muscular layers) and supraglottoplasty [ 2 , 4 , 7 , 8 ].…”