Skip to main content
SpringerLink
Log in

Lateral pharyngoplasty: polysomnographic results and phenotype-based analysis of OSA

  • ENT • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

There are several surgical treatments for obstructive sleep apnea (OSA) including lateral pharyngoplasty (LP) have yielded promising results, clearly improving symptoms of the disease. However, there are few publications in relation to polysomnographic (PSG) results, and patient selection remains a challenge. There are currently four pathophysiological phenotypes for OSA: anatomical, low arousal threshold, ventilatory instability, and poor muscle response. This study sought to evaluate the PSG results of LP and to verify whether the phenotypic profile is predictive of surgical success.

Methods

This was an observational, retrospective, cross-sectional study that analyzed the PSG results (pre-surgical and at least 6 months after surgery) of patients treated with Cahali’s LP. To assess phenotypes, the following variables of interest (obtained from the pre-operative PSG) were used: apnea–hypopnea index (AHI) during REM sleep (AHIrem), percentage of hypopneas in the AHI, number of central or mixed apneas, and AHIrem and non-REM AHI ratio.

Results

Of 46 patients, it was possible to evaluate the phenotype in 28 patients. There were significant differences in the AHI values, ranging from 37.5 (20.8–49.7) to 10.3 (2.3–33.0) (p < 0.001). The minimum oxyhemoglobin saturation ranged from 78 ± 11 to 83 ± 8 p = 0.008. The time with oxyhemoglobin saturation < 90% ranged from 3.6 min (0.5–9.1) to 0.0 (0.0–1.5) p = 0.031. An AHIrem of < 20 events/h showed a positive correlation with surgical success.

Conclusion

LP is efficient for the treatment of OSA, yielding significant improvement in all respiratory parameters evaluated by PSG. A pre-operative AHIrem of < 20 events/h was associated with surgical success. Other variables of interest for determining the phenotypes were not predictors of surgical success.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Eckert D, Malhotra A (2008) Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5(2):144–153

    Article  PubMed  PubMed Central  Google Scholar 

  2. Zancanella E, Haddad F, Oliveira L, Nakasato A, Duarte BB, Soares C (2014) Obstructive sleep apnea and primary snoring: diagnosis (vol 80, pg S1, 2014). Braz J Otorhinolaryngol 80(5):457

    Article  Google Scholar 

  3. Senaratna CV, Perret JL et al (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81

    Article  PubMed  Google Scholar 

  4. Tuffik S, Santos Silva R, Taddei JA, Bittencourt LRA (2010) Obstructive sleep apnea syndrome in São Paulo Epidemiologic Sleep Study. Sleep Med 11:441–446

    Article  Google Scholar 

  5. American Academy of Sleep Medicine. International classification of sleep disorders (2005). Diagnostic and coding manual (ICSD-2). 2nd ed. Westchester, IL

  6. Haba-Rubio J, Vujica J, Franc Y, Michel P, Heinzer R (2019) Effect of CPAP treatment of sleep apnea on clinical prognosis after ischemic stroke: an observational study. J Clin Sleep Med 15(6):839–847. https://doi.org/10.5664/jcsm.7832.PMID:31138378;PMCID:PMC6557650

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cahali MB, Lorenzetti FTM, Kobayashi, DY, Pinheiro-Neto CD (2018). Tratamento Cirúrgico para ronco e apneia. In: Tratado de Otorrinolaringologia. 3a. ed. Elsevier. Rio de Janeiro. pp 202–11

  8. Cahali MB (2003) Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope 113(11):1961–1968

    Article  PubMed  Google Scholar 

  9. Cahali MB, Formigoni GG, Gebrim EM, Miziara ID (2004) Lateral pharyngoplasty versus uvulopalatopharyngoplasty: a clinical, polysomnographic and computed tomography measurement comparison. Sleep 27(5):942–950

    Article  PubMed  Google Scholar 

  10. Soares CP, Cavichio L, Cahali MB (2014) Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea. Laryngoscope 124(1):311–316

    Article  Google Scholar 

  11. Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89(6):923–934

    Article  CAS  PubMed  Google Scholar 

  12. Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137(1):110–114. https://doi.org/10.1016/j.otohns.2007.03.014

    Article  PubMed  Google Scholar 

  13. Hur J (2008) A new treatment for snoring: sling snoreplasty with a permanent thread. Acta Otolaryngol 128(12):1381–1384. https://doi.org/10.1080/00016480801968500

    Article  PubMed  Google Scholar 

  14. Vicini C, Montevecchi F, Campanini A, Dallan I, Hoff PT, Spector ME, Thaler E, Ahn J, baptista P, Remacle M, Lawson G, Benazzo M, Canzi P, (2014) Clinical outcomes and complications associated with TORS for OSAHS: a benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. ORL J Otorhinolaryngol Relat Spec 76(2):63–69. https://doi.org/10.1159/000360768

    Article  PubMed  Google Scholar 

  15. Eastwood PR, Barnes M, MaCkay SG, Wheatley JR, Hillman DR, Nguyên XL, Lewis R, Campbell MC, Pételle B, Walsh JH, Jones AC, Bizon Palme CE., A, Meslier N, Bertolus C, Maddison KJ, Laccourreye L, Raux G, Denoncin K, Attali V, Gagnadoux F, Launois SH, (2020) Bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnoea. Eur Respir J 9(551):1901320. https://doi.org/10.1183/13993003.01320-2019

    Article  Google Scholar 

  16. Jacobowitz O, Woodson BT (2019) A new metric for precision medicine: PAP and hypoglossal neurostimulation. J Clin Sleep Med 15(8):1079–1080. https://doi.org/10.5664/jcsm.7862

    Article  PubMed  PubMed Central  Google Scholar 

  17. Awad M, Capasso R (2020) Skeletal surgery for obstructive sleep apnea. Otolaryngol Clin North Am 53(3):459–468. https://doi.org/10.1016/j.otc.2020.02.008

    Article  PubMed  Google Scholar 

  18. Tan KB, Toh ST, Guilleminault C, Holty JE (2014) A cost-effectiveness analysis of surgery for middle-aged men with severe obstructive sleep apnea intolerant of CPAP. J Clin Sleep Med 11(05):525–535. https://doi.org/10.5664/jcsm.4696

    Article  Google Scholar 

  19. Camacho M, Certal V, Capasso R (2013) Comprehensive review of surgeries for obstructive sleep apnea syndrome. Braz J Otorhinolaryngol 79(6):780–788

    Article  PubMed  Google Scholar 

  20. Elzayat S, El-Sobki E-D, Moussa HH (2020) Managing obstructive sleep apnea patients with CPAP failure with a novel lateral pharyngoplasty as a stand-alone procedure. Am J Otolaryngol 41(4):102500. https://doi.org/10.1016/j.amjoto.2020.102500

    Article  PubMed  Google Scholar 

  21. Puccia R, Woodson BT (2020) Palatopharyngoplasty and palatal anatomy and phenotypes for treatment of sleep apnea in the twenty-first century. Otolaryngologic Clinics of North Americ 53(3):421–429 (ISSN 0030-6665, SBN 9780323732901)

    Article  Google Scholar 

  22. Eckert DJ (2018) Phenotypic approaches to obstructive sleep apnoea – new pathways for target therapy. Sleep Med Rev 37:45–59

    Article  PubMed  Google Scholar 

  23. Li Y, Ye J, Han D, Cao X, Ding X, Zhang Y, Xu W, Orr J, Jen R, Sands S, Malhotra A, Owens R (2017) Physiology-based modeling may predict surgical treatment outcome for obstructive sleep apnea. J Clin Sleep Med 13(9):1029–1037. https://doi.org/10.5664/jcsm.6716

    Article  PubMed  PubMed Central  Google Scholar 

  24. Friedman MOJ, Ibrahim H, Joseph NJ (2004) Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 114(3):454–459

    Article  PubMed  Google Scholar 

  25. Vidigal TA, Haddad FL, Cabral RF, Oliveira MC, Cavalcante RR, Bittencourt LR et al (2014) New clinical staging for pharyngeal surgery in obstructive sleep apnea patients. Braz J Otorhinolaryngol 80(6):490–496

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19(2):156–177

    Article  CAS  PubMed  Google Scholar 

  27. Cammaroto G, Montevecchi F, D’Agostino G et al (2017) Palatal surgery in a transoral robotic setting (TORS): preliminary results of a retrospective comparison between uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP) and barbed repositioning pharyngoplasty (BRP). Acta Otorhinolaryngol Ital 37:406–409

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Rashwan MS, Montevecchi F, Cammaroto G et al (2018) Evolution of soft palate surgery techniques for obstructive sleep apnea patients: a comparative study for single-level palatal surgeries. Clin Otolaryngol 43:584–590

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The present work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel (CAPES) — Brazil.

Funding

The present work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel — Brazil — Financing Code 001.

Author information

Authors and Affiliations

  1. Pontifical Catholic University of Campinas and Campinas State University, Zip Code, Avenida John Boyd Dunlop, Campinas/SP, 13034-685, Brazil

    Felipe Almeida Mendes, Aurelio Rochael Almeida, Bruno Bernardo Duarte & José Alexandre Mendonça

Authors
  1. Felipe Almeida Mendes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aurelio Rochael Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bruno Bernardo Duarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. José Alexandre Mendonça
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Felipe Almeida Mendes. The first draft of the manuscript was written by Felipe Almeida Mendes, and all the authors commented on the previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Felipe Almeida Mendes.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mendes, F.A., Almeida, A.R., Duarte, B.B. et al. Lateral pharyngoplasty: polysomnographic results and phenotype-based analysis of OSA. Sleep Breath 27, 1125–1134 (2023). https://doi.org/10.1007/s11325-022-02706-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-022-02706-y

Keywords

Search

Navigation