Sleep & breathing = Schlaf & Atmung · 2026
Single-stage multilevel surgery: expansion sphincter pharyngoplasty, anterior palatoplasty, tongue base resection in obstructive sleep apnea.
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Çufalı Ömer Faruk, Özcan Kürşat Murat, Fırat Selma
Аннотация
PURPOSE: To evaluate the efficacy and safety of a standardized, drug-induced sleep endoscopy guided, single-stage multilevel protocol combining expansion sphincter pharyngoplasty (ESP), anterior palatoplasty, and coblation-assisted tongue base resection in positive airway pressure (PAP)-intolerant obstructive sleep apnea (OSA).
METHODS: Twenty adults with OSA (19 men, 1 woman) underwent single-stage ESP, anterior palatoplasty, and coblation-assisted tongue base resection. Preoperative and 3-month postoperative polysomnography and Epworth Sleepiness Scale (ESS) scores were compared; postoperative adverse events were recorded during follow-up.
RESULTS: Mean age was 43.75 ± 11.85 years. ESS decreased from 11.5 (IQR 9.0) to 4.5 (IQR 6.0) (p < 0.001). Overall AHI decreased from 17.55 events/h (IQR 12.43) to 7.05 events/h (IQR 8.55) (p < 0.001). Minimum oxygen saturation increased from 84% (IQR 7) to 87% (IQR 4) (p = 0.039), and T90 decreased from 2.85% (IQR 15.38) to 0.25% (IQR 1.85) (p = 0.003). After excluding recordings with < 60 min of supine sleep, supine AHI decreased from 28.3 to 7.8 events/h (n = 15; p = 0.002). Surgical success (postoperative AHI < 20 and > 50% reduction) was achieved in 13/20 (65%); 9/20 (45%) achieved postoperative AHI < 5. No major complications occurred.
CONCLUSION: Single stage multilevel surgery combining ESP, anterior palatoplasty, and coblation-assisted tongue base resection provides significant short-term improvements in symptoms, polysomnographic indices, and nocturnal oxygenation, with a favorable safety profile in PAP-intolerant OSA.
METHODS: Twenty adults with OSA (19 men, 1 woman) underwent single-stage ESP, anterior palatoplasty, and coblation-assisted tongue base resection. Preoperative and 3-month postoperative polysomnography and Epworth Sleepiness Scale (ESS) scores were compared; postoperative adverse events were recorded during follow-up.
RESULTS: Mean age was 43.75 ± 11.85 years. ESS decreased from 11.5 (IQR 9.0) to 4.5 (IQR 6.0) (p < 0.001). Overall AHI decreased from 17.55 events/h (IQR 12.43) to 7.05 events/h (IQR 8.55) (p < 0.001). Minimum oxygen saturation increased from 84% (IQR 7) to 87% (IQR 4) (p = 0.039), and T90 decreased from 2.85% (IQR 15.38) to 0.25% (IQR 1.85) (p = 0.003). After excluding recordings with < 60 min of supine sleep, supine AHI decreased from 28.3 to 7.8 events/h (n = 15; p = 0.002). Surgical success (postoperative AHI < 20 and > 50% reduction) was achieved in 13/20 (65%); 9/20 (45%) achieved postoperative AHI < 5. No major complications occurred.
CONCLUSION: Single stage multilevel surgery combining ESP, anterior palatoplasty, and coblation-assisted tongue base resection provides significant short-term improvements in symptoms, polysomnographic indices, and nocturnal oxygenation, with a favorable safety profile in PAP-intolerant OSA.