The effectiveness of combined tonsillectomy and anterior palatoplasty in the treatment of snoring and obstructive sleep apnoea (OSA)

Abstract

The prevalence of obstructive sleep apnoea (OSA) is increasing due to a rising rate of obesity. Multiple surgical techniques used to address obstruction at the palatal level have been associated with significant morbidities. Few studies have reported good outcomes of anterior palatoplasty (AP) in mild-to-moderate OSA. The aim of this study is to investigate the effectiveness of combining tonsillectomy and anterior palatoplasty in the treatment of snoring and OSA. All patients with snoring and OSA treated with tonsillectomy and anterior palatoplasty were analyzed. The primary outcome was reduction of the apnoea hypopnoea index (AHI) with surgical success criteria; reduction of AHI by ≥50% and AHI ≤10. The secondary outcomes measured were patients' Epworth Sleepiness Scale (ESS) and snoring visual analogue scale (VAS) scores. Thirty one patients completed the study, where 19% had mild, 42% moderate, and 39% had severe OSA. The mean surgical success rate was 45% at 3 months and 32% at 1-year post-operatively. There was a significant reduction of ESS and VAS at 3 months and 1-year post-operatively (p < 0.05). Combination of tonsillectomy and anterior palatoplasty could be considered as a treatment option for snoring and OSA in selected groups of patients (mild-to-moderate OSA with mainly retropalatal obstruction). The surgical success was found to reduce with time, and BMI optimization should be emphasized as part of post-operative care.

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

“…Patients with severe OSA are not considered candidates for AP because of the difficulty of reducing AHI levels in these patients using this technique. The severest mean preoperative AHI level was reported in the study of Adzreil et al 14 ; therefore, the lowest success rate was obtained in that study among those included in this meta‐analysis. However, the studies by Pang et al 8 and Marzetti et al 11 included patients mostly with moderate OSA, and they obtained 72% and 86% success rates, respectively.…”

“…The minimum and maximum follow‐up periods were 3 months and 33.5 months, respectively. The highest and lowest surgical success rates were obtained in the studies by Marzetti et al 11 (86%) and Adzreil et al 14 (45.2%), respectively. The largest study sample was reached in the study by Ugur et al 12 (n = 41), and the lowest number of patients was 8 in the study by Pang et al 7 ( Table 1 ).…”

“…Of the 308 articles found through the database searches, 294 studies were excluded. After evaluation of the remaining 14 studies carefully as full texts, 6 studies finally met the criteria for inclusion in the present meta‐analysis 7,8,11‐14 . In accordance with the purpose of this study, primary snoring cases were not included.…”

“…In this meta‐analysis, our aim was to assess the single effect of AP surgery, so we did not include studies of patients who underwent AP concurrently with other surgical procedures (except for tonsillectomy). In 2 studies in this meta‐analysis, the authors performed concomitant tonsillectomy with AP 11,14 . Their success rates were 86% and 45%, respectively; however, their definition of success criteria was relatively more restricted, as a reduction in the AHI of ≥50% and postoperative AHI ≤10 events/h.…”

“…In 2 studies in this meta-analysis, the authors performed concomitant tonsillectomy with AP. 11,14 Their success rates were 86% and 45%, respectively; however, their definition of success criteria was relatively more restricted, as a reduction in the AHI of ≥50% and postoperative AHI ≤10 events/h. We also suggest that, when indicated, tonsillectomy can be performed with AP.…”