Echocardiographic effects of expansion sphincter pharyngoplasty in obstructive sleep apnea patients.

OBJECTIVE

Expansion sphincter pharyngoplasty (ESP) is an effective surgical technique for treating obstructive sleep apnea syndrome (OSAS). This study evaluates the impact of ESP on cardiac complications and morbidities by analyzing patients’ echocardiographic findings.

METHODS

25 OSAS patients (aged 18–65) intolerant to Continuous Positive Airway Pressure (CPAP) therapy, who underwent ESP surgery between May 2019 and August 2022. Preoperative and postoperative (six months after surgery) polysomnography (PSG) data and echocardiographic findings were evaluated. Surgical success based on Sher criteria was defined by a > 50% reduction in the apnea-hypopnea index (AHI) and postoperative AHI < 20. The Epworth Sleepiness Scale was used to assess symptomatic improvement.

RESULTS

The mean AHI decreased from 27.76 ± 18.54 preoperatively to 18.08 ± 18.82 postoperatively (p < 0.001), with a surgical success rate of 56%. No significant correlation was found between success rate or AHI change and gender, age, or disease severity. In the successful group, significant improvements were seen in right ventricular parameters, including systolic pulmonary artery pressure (SPAP) (28.00 ± 4.00 to 24.79 ± 2.54, p = 0.006), pulmonary vascular resistance (PVR) (1.79 ± 0.33 to 1.61 ± 0.27, p = 0.013), and right ventricular thickness (RV) (0.53 ± 0.10 to 0.46 ± 0.06, p = 0.008). Tricuspid annular plane systolic excursion (TAPSE) also increased significantly (2.22 ± 0.15 to 2.37 ± 0.15, p = 0.01).

CONCLUSION

In our study involving OSAS patients without known cardiac disease, follow-up after successful ESP surgery demonstrated significant improvement in echocardiographic parameters, particularly those associated with right ventricular function. Appropriate patient selection combined with effective ESP surgery can lead to substantial reductions in AHI values, potentially contributing to the prevention of subclinical cardiac complications in this patient population.