The aim of this study was to analyze both short-term and long-term results of the expansion sphincter pharyngoplasty surgery, which is commonly used in obstructive sleep apnea syndrome (OSAS) and to compare it with objective and subjective methods.
Patients who underwent expansion sphincter pharyngoplasty were included in the study. Polysomnography at postoperative sixth-month, Epworth Sleepiness Scale, and visual analog score of snoring (VAS) were used to assess short-term results. Epworth Sleepiness Scale (ESS) and visual analog score of snoring (VAS) at postoperative third-year were used for long-term results. Sixth-month and third-year data before and after the surgery were compared. Possible complications and morbidity rates related to surgery were evaluated.
Of 39 patients, OSAS was assessed as mild in 16 (41%), moderate in 14 (36%), and severe in 9 (23%). Mean age of patients was 43.2 ± 7.5, and 21 were men (54%). According to postoperative six-month PSG data, the apnea hypopnea index (AHI) values decreased significantly from 25.2 ± 8.3 to 11.6 ± 6.9/h, p=0.012. There were decreases in ESS from baseline to 6-month and 3-years from 10.4, to 4.4, and 4.4, and VAS scores changed from 8.6 to 1.6 and 1.9, p<0.05. No serious complications were observed in patients in the early and late postoperative period.
The expansion sphincter pharyngoplasty procedure is an important option for OSAS surgery with long-term effective results and low morbidity and complication rates.
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Sowho M, Sgambati F, Guzman M, Schneider H, Schwartz A (2020) Snoring: a source of noise pollution and sleep apnea predictor. Sleep 43(6):zsz305. https://doi.org/10.1093/sleep/zsz305
Tan S, Liu X, Xu Y, Luo L, Zhou S, Gao Y (2017) Serum high-density lipoprotein correlates with serum apolipoprotein M and A5 in obstructive sleep apnea hypopnea syndrome. Sleep Breath 21(1):37–44. https://doi.org/10.1007/s11325-016-1357-5
Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20(9):705–706. https://doi.org/10.1093/sleep/20.9.705
Hizli O, Cayir S, Coluk Y, Kayabasi S, Yildirim G (2020) The novel indicators of moderate to severe sleep apnea: fibrinogen to albumin ratio vs. CRP to albumin ratio. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-019-05770-5
Ellis PD (1994) Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol Allied Sci 19(4):350–351. https://doi.org/10.1111/j.1365-2273.1994.tb01245.x
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
Friedman M, Ibrahim H, Joseph NJ (2004) Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 114(3):454–459. https://doi.org/10.1097/00005537-200403000-00013
Engleman HM, Martin SE, Douglas NJ (1994) Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 49(3):263–266
Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I (2008) Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 12(2):161–168. https://doi.org/10.1007/s11325-007-0145-7
Cayir S, Hizli O, Kayabasi S, Yildirim G (2020) Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy. Braz J Otorhinolaryngol S1808-8694(20):30028–30028. https://doi.org/10.1016/j.bjorl.2020.02.003
Soares D, Sinawe H, Folbe AJ, Yoo G, Badr S, Rowley JA, Lin HS (2012) Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope 122(2):473–479. https://doi.org/10.1002/lary.22474
Schellenberg JB, Maislin G, Schwab RJ (2000) Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med 162(2 Pt 1):740–748. https://doi.org/10.1164/ajrccm.162.2.9908123
Genta PR, Sands SA, Butler JP, Loring SH, Katz ES, Demko BG, Kezirian EJ, White DP, Wellman A (2017) Airflow shape is associated with the pharyngeal structure causing OSA. Chest 152(3):537–546. https://doi.org/10.1016/j.chest.2017.06.017
Pang KP, Pang EB, Win MT, Pang KA, Woodson BT (2016) Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis. Eur Arch Otorhinolaryngol 273(9):2329–2333. https://doi.org/10.1007/s00405-015-3831-2
Plaza G, Baptista P, O'Connor-Reina C, Bosco G, Pérez-Martín N, Pang KP (2019) Prospective multi-center study on expansion sphincter pharyngoplasty. Acta Otolaryngol 139(2):219–222. https://doi.org/10.1080/00016489.2018.1533992
Karakoc O, Binar M, Aydin U, Genc H, Akcam T, Gerek M (2018) A tertiary center experience with velopharyngeal surgical techniques for treatment of snoring and obstructive sleep apnea. Auris Nasus Larynx 45(3):492–498. https://doi.org/10.1016/j.anl.2017.06.005
Despeghel AS, Mus L, Dick C, Vlaminck S, Kuhweide R, Lerut B, Speleman K, Vinck AS, Vauterin T (2017) Long-term results of a modified expansion sphincter pharyngoplasty for sleep-disordered breathing. Eur Arch Otorhinolaryngol 274(3):1665–1670. https://doi.org/10.1007/s00405-016-4395-5
The Ethic Committee at Faculty of Medicine, Aksaray University approved the study protocol. The reference number of the study approval was REC 2020/06-72. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/ or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all participants.
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Cayir, S., Yesildag, K. & Kayabasi, S. Long-term efficacy of expansion sphincter pharyngoplasty in obstructive sleep apnea syndrome. Sleep Breath (2021). https://doi.org/10.1007/s11325-021-02315-1
- Obstructive sleep apnea
- Expansion pharyngoplasty
- Continuous positive airway pressure