Expansion sphincter pharyngoplasty may help some with sleep apnea

By David Douglas

NEW YORK (Reuters Health) - 14/3/2019

Expansion sphincter pharyngoplasty could be a useful surgical option in certain patients with obstructive sleep apnea (OSA), a retrospective study from South Korea hints.

In a paper online March 7 in JAMA Otolaryngology-Head & Neck Surgery, Dr. Hyun Jik Kim of Seoul National University College of Medicine and colleagues note that greater lateral pharyngeal collapsibility is found in patients with OSA who experience a relapse of snoring or apnea after surgery.

Expansion sphincter pharyngoplasty (ESP) has been used to correct lateral pharyngeal collapse, and the team sought to evaluate its clinical utility in conjunction with other surgical procedures in OSA.

The researchers studied data on 63 patients with moderate or severe OSA who were diagnosed with lateral pharyngeal collapse under drug-induced sleep endoscopy. The patients underwent ESP combined with tonsillectomy, uvuloplasty, or nasal surgery between 2015 and 2016.

Mean baseline apnea-hypopnea index (AHI) in the whole group was 35.5, which at six months after the procedure had fallen significantly to 17.3. There was also a corresponding increase in oxygen saturation from 78.2% to 86.4%.

Based on an arbitrary threshold of a 50% reduction in AHI plus an AHI less than 20, say the researchers, "the number of responders was 42 for a success rate of sleep surgery (including ESP) of 67% in patients with OSA and lateral pharyngeal collapse." The rate of postoperative complications "was minimal."

Despite the apparent success of the approach, the researchers caution that "further research, including randomized clinical trials with appropriate control groups, is required to reach definitive conclusions about appropriate indications and the efficacy of the ESP procedure."

Dr. James A. Rowley of Harper University Hospital, in Detroit, who is division chief of pulmonary/critical care and sleep medicine, told Reuters Health by email, "This study indicates that expansion sphincter pharyngoplasty may be a promising surgical technique to reduce sleep-apnea severity. It also led to improvements in oxygen saturation at night as well as excessive daytime sleepiness."

However, added Dr. Rowley, who was not involved in the study, "the surgical procedure was performed on a highly select group of patients who had specific findings of airway collapse during pre-operative visualization of the upper airway by an ear/nose/throat surgeon. Thus, this surgical procedure is not for the average sleep-apnea patient. Patients interested in surgery for their sleep apnea should find a surgeon with the required expertise in surgical procedures for this disorder."

Dr. Kim did not respond to requests for comments.

SOURCE: https://bit.ly/2Hk2xmM

JAMA Otolaryngol Head Neck Surg 2019.

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