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03.01.2022 | Sleep Breathing Physiology and Disorders • Review

Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis

verfasst von: Antonino Maniaci, Milena Di Luca, Jerome René Lechien, Giannicola Iannella, Calogero Grillo, Caterina Maria Grillo, Federico Merlino, Christian Calvo-Henriquez, Andrea De Vito, Giuseppe Magliulo, Annalisa Pace, Claudio Vicini, Salvatore Cocuzza, Vittoria Bannò, Isabella Pollicina, Giovanna Stilo, Alberto Bianchi, Ignazio La Mantia

Erschienen in: Sleep and Breathing | Ausgabe 4/2022

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Abstract

Objectives

To compare the efficacy and success rates of lateral pharyngoplasty techniques (LP) vs. uvulopalatopharyngoplasty (UPPP) among adult patients surgically treated for obstructive sleep apnea.

Methods

A systematic literature review of the last 20 years’ papers was conducted using PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library until April 2021. Only full-text English articles comparing LP and UPPP outcomes in adult patients with objective outcomes were included in the study.

Results

We included 9 articles for a total of 312 surgically treated patients with OSA. LP techniques for obstructive sleep apnea were used on 186 (60%) subjects, while 126 patients (40%) were treated with UPPP. Both surgical procedures resulted in significant improvements in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and lowest oxygen saturation (LOS) (p < 0.001 in all cases). Although better outcomes were reported with lateral pharyngoplasty, the differences were not significant compared to UPPP post-operative results (p > 0.05 in all cases).

Conclusions

UPPP and LP are both effective surgical procedures in treating OSA in adults. Although not significant, LPs demonstrated improved post-operative outcomes. However, further evidence comparing the surgical effect on patients with OSA is needed to discriminate post-operative outcomes.

Bilston LE, Gandevia SC (1985) Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea. J Appl Physiol 116(3):314–324 CrossRef

Iannella G, Maniaci A, Magliulo G et al (2020) Current challenges in the diagnosis and treatment of obstructive sleep apnea syndrome in the elderly. Pol Arch Intern Med 130(7–8):649–654 PubMed

Kushida CA, Littner MR, Hirshkowitz M et al (2006) American Academy of Sleep Medicine. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380. https://doi.org/10.1093/sleep/29.3.375 CrossRefPubMed

Li MX, Yan CY, Wang S (2015) New insights on the role of the insular cortex and habenula in OSA. Sleep Breath 19(4):1347–1353 CrossRefPubMed

Di Luca M, Iannella G, Montevecchi F et al (2020) Use of the transoral robotic surgery to treat patients with recurrent lingual tonsillitis. Int J Med Robot 16(4):e2106. https://doi.org/10.1002/rcs.2106 CrossRefPubMed

Pieters T, Collard P, Aubert G et al (1996) Acceptance and longterm compliance with nCPAP in patients with obstructive sleep apnoea syndrome. Eur Respir J 9:939–944 CrossRefPubMed

Ravesloot MJL, de Vries N, Stuck BA (2014) Treatment adherence should be taken into account when reporting treatment outcomes in obstructive sleep apnea. Laryngoscope 124:344–345 CrossRefPubMed

Vicini C, De Vito A, Benazzo M et al (2012) The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 269:1297–1300 CrossRefPubMed

De Vito A, Carrasco Llatas M, Vanni A et al (2014) European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 18:453–465 CrossRefPubMed

10.

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 CrossRefPubMed

11.

Golbin D, Musgrave B, Succar E, Yaremchuk K (2016) Clinical analysis of drug-induced sleep endoscopy for the OSA patient. Laryngoscope 126(1):249–253 CrossRefPubMed

12.

Dickson RI, Blokmanis A (1987) Treatment of obstructive sleep apnea by uvulopalatopharyngoplasty. Laryngoscope 97:1054–1059 CrossRefPubMed

13.

Tang JA, Salapatas AM, Bonzelaar LB, Friedman M (2017) Long-term incidence of velopharyngeal insufficiency and other sequelae following uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 156(4):606–610 CrossRefPubMed

14.

Röösli C, Schneider S, Häusler R (2006) Long-term results and complications following uvulopalatopharyngoplasty in 116 consecutive patients. Eur Arch Otorhinolaryngol 263:754–758 CrossRefPubMed

15.

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

16.

Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137:110–114 CrossRefPubMed

17.

Hong S, Kim HG, Han S et al (2019) Indications for and outcomes of expansion sphincter pharyngoplasty to treat lateral pharyngeal collapse in patients with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 145(5):405–412 CrossRefPubMedPubMedCentral

18.

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 273:2329–2333 CrossRefPubMed

19.

Vicini C, Hendawy E, Campanini A, Eesa M, Bahgat A, AlGhamdi S et al (2015) Barbed reposition pharyngoplasty (BRP) for OSAHS: a feasibility, safety, efficacy and teachability pilot study. “We are on the giant’s shoulders.” Eur Arch Otorhinolaryngol 272(10):3065–70 CrossRefPubMed

20.

Iannella G, Vallicelli B, Magliulo G et al (2020) Long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome treatment. Int J Environ Res Public Health 17(5):1542. https://doi.org/10.3390/ijerph17051542 CrossRefPubMedCentral

21.

Montevecchi F, Meccariello G, Firinu E et al (2018) Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea. Clin Otolaryngol 43:483–488 CrossRefPubMed

22.

Gulotta G, Iannella G, Meccariello G et al (2021) Barbed suture extrusion and exposure in palatoplasty for OSA: what does it mean? Am J Otolaryngol 42(4):102994 CrossRefPubMed

23.

Moher D, Shamseer L, Clarke M, PRISMA-P Group et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1):1. https://doi.org/10.1186/2046-4053-4-1 CrossRefPubMedPubMedCentral

24.

Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536 CrossRefPubMed

25.

Zhou Y, Dendukuri N (2014) Statistics for quantifying hetero-geneity in univariate and bivariate meta-analyses of binary data: the case of meta-analyses of diagnostic accuracy. Stat Med 33(16):27012717 CrossRef

26.

Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455e63. https://doi.org/10.1111/j.0006-341x.2000.00455.x CrossRef

27.

Cammaroto G, Montevecchi F, D’Agostino G, Zeccardo E, Bellini C, Meccariello G, Vicini C (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(5):406–409. https://doi.org/10.14639/0392-100X-1321 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

29.

Carrasco-Llatas M, Marcano-Acuña M, Zerpa-Zerpa V, Dalmau-Galofre J (2015) Surgical results of different palate techniques to treat oropharyngeal collapse. Eur Arch Otorhinolaryngol 272:2535–2540 CrossRefPubMed

30.

Vicini C, Montevecchi F, Pang K, Bahgat A, Dallan I, Frassineti S, Campanini A (2013) Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty. Head Neck 36(1):77–83 CrossRefPubMed

31.

Dizdar D, Civelek Ş, Çaliş ZA, Dizdar SK, Coşkun BU, Vural A (2015) Comparative analysis of lateral pharyngoplasty and uvulopalatopharyngoplasty techniques with polisomnography and Epworth sleepiness scales. J Craniofac Surg 26(7):e647–e651. https://doi.org/10.1097/SCS.0000000000001979 CrossRefPubMed

32.

Steinbichler TB, Bender B, Giotakis AI, Dejaco D, Url C, Riechelmann H (2018) Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty. Eur Arch Otorhinolaryngol 275(2):623–628 CrossRefPubMed

33.

Chi JC, Chiang RP, Chou TY, Shu CH, Shiao AS, Lin CM (2015) The role of lateral pharyngoplasty in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 272(2):489–496. https://doi.org/10.1007/s00405-014-3253-6 CrossRefPubMed

34.

Rashwan MS, Montevecchi F, Firinua E et al (2018) Let’s know from our patients: PPOPS score for palate surgery evaluation/a pilot study. Eur Arch Otorhinolaryngol 275(1):287–291. https://doi.org/10.1007/s00405-017-4795-1 CrossRefPubMed

35.

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

36.

Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Redline S (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med 8:597–619 CrossRefPubMedPubMedCentral

37.

Maniaci A, Iannella G, Cocuzza S et al (2021) Oxidative stress and inflammation biomarker expression in obstructive sleep apnea patients. J Clin Med 10(2):277. https://doi.org/10.3390/jcm10020277 CrossRefPubMedCentral

38.

Iannella G, Magliulo G, Maniaci A et al (2021) Olfactory function in patients with obstructive sleep apnea: a meta-analysis study. Eur Arch Otorhinolaryngol 278(3):883–891. https://doi.org/10.1007/s00405-020-06316-w CrossRefPubMed

39.

Young T, Finn L, Peppard PE et al (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31:1071–1078 PubMedPubMedCentral

40.

Pace A, Iannella G, Rossetti V et al (2020) Diagnosis of obstructive sleep apnea in patients with allergic and non-allergic rhinitis. Medicina (Kaunas) 56(9):454. https://doi.org/10.3390/medicina56090454 CrossRef

41.

Hewitt RJD, Dasgupta A, Singh A, Dutta C, Kotecha BT (2009) Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction? Eur Arch Otorhinolaryngol 266:691–697 CrossRefPubMed

42.

Eichler C, Sommer JU, Stuck BA, Hörmann K, Maurer JT (2013) Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath 17:63–68 CrossRefPubMed

43.

Fernández-Julián E, García-Pérez M, García-Callejo J, Ferrer F, Martí F, Marco J (2014) Surgical planning after sleep versus awake techniques in patients with obstructive sleep apnea. Laryngoscope 124(8):1970–1974 CrossRefPubMed

44.

Zerpa Zerpa V, Carrasco Llatas M, Agostini Porras G, Dalmau Galofre J (2015) Drug-induced sedation endoscopy versus clinical exploration for the diagnosis of severe upper airway obstruction in OSAHS patients. Sleep Breath 19(4):1367–1372 CrossRefPubMed

45.

Iannella G, Magliulo G, di Luca M et al (2020) Lateral pharyngoplasty techniques for obstructive sleep apnea syndrome: a comparative experimental stress test of two different techniques. Eur Arch Otorhinolaryngol 277:1793–1800 CrossRefPubMed

46.

Grillo C, La Mantia I, Zappala G, Cocuzza S, Ciprandi G, Andaloro C (2019) Oral health in children with sleep-disordered breathing: a cross-sectional study. Acta Biomed 90(7-S):52–59. https://doi.org/10.23750/abm.v90i7-S.8661 CrossRefPubMed

47.

Värendh M, Berg S, Andersson M (2012) Long-term follow-up of patients operated with uvulopalatopharyngoplasty from 1985 to 1991. Respir Med 106:1788–1793 CrossRefPubMed

48.

Goh YH, Mark I, Fee WE Jr (2007) Quality of life 17 to 20 years after uvulopalatopharyngoplasty. Laryngoscope 117:503–506 CrossRefPubMed

49.

Haavisto L, Suonpaa J (1994) Complications of uvulopalatopharyngoplasty. Clin Otolaryngol Allied Sci 19:243–247 CrossRefPubMed

50.

51.

Modica DM, Lorusso F, Presti G, Fasola S, Gallina S (2019) Our assessment using palate postoperative problems score (PPOPS): tool for the evaluation of results in palatal surgery techniques. Indian J Otolaryngol Head Neck Surg 71(Suppl 1):766–770. https://doi.org/10.1007/s12070-018-1540-z CrossRefPubMed

Titel: Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis
verfasst von: Antonino Maniaci
Milena Di Luca
Jerome René Lechien
Giannicola Iannella
Calogero Grillo
Caterina Maria Grillo
Federico Merlino
Christian Calvo-Henriquez
Andrea De Vito
Giuseppe Magliulo
Annalisa Pace
Claudio Vicini
Salvatore Cocuzza
Vittoria Bannò
Isabella Pollicina
Giovanna Stilo
Alberto Bianchi
Ignazio La Mantia
Publikationsdatum: 03.01.2022
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 4/2022
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02520-y

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Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis

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Objectives

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