Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review
<i>Background</i><b>:</b> In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifti...
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| Format: | Article |
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MDPI AG
2023-06-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/6/1147 |
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| author | Ana Maria Vlad Cristian Dragos Stefanescu Iemima Stefan Viorel Zainea Razvan Hainarosie |
| author_facet | Ana Maria Vlad Cristian Dragos Stefanescu Iemima Stefan Viorel Zainea Razvan Hainarosie |
| author_sort | Ana Maria Vlad |
| collection | DOAJ |
| description | <i>Background</i><b>:</b> In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess soft tissue to less invasive reconstruction techniques that aim to preserve pharyngeal function while effectively managing sleep apnea. This review aims to evaluate and compare the efficacy of the surgical techniques utilized for OSA at the level of the palate and pharynx. It will cover both traditional and novel procedures. <i>Methods:</i> A comprehensive search of the major databases, such as PubMed/MEDLINE, Web of Science, and Scopus, was conducted to identify the relevant literature. We included articles written in English that analyzed the outcomes of adult patients who received velopharyngeal surgery for sleep apnea. Only comparative studies that examined at least two techniques were considered. <i>Results:</i> In all of the studies combined, the total number of patients who underwent velopharyngeal surgery was 614 in eight studies. All surgical procedures resulted in improvements in the apnea–hypopnea index (AHI). The highest success rates and best outcomes were achieved by barbed reposition pharyngoplasty (BRP) in most studies, ranging from 64.29% to 86.6%. BRP also demonstrated the most significant improvements in both objective and subjective parameters closely followed by ESP that obtained similar efficiency in some studies, especially when combined with anterior palatoplasty (AP), but with a higher incidence of complications. While LP showed moderate efficiency compared with BRP or ESP, the UPPP techniques exhibited greater outcome variability among studies, with a success rate ranging from 38.71% to 59.26%, and the best results observed in a multilevel context. <i>Conclusions:</i> In our review, BRP was the most preferred, effective, and safe among all velopharyngeal techniques, closely followed by ESP. However, older described techniques also showed good results in well-selected patients. Larger-scale studies, preferably prospective, that rigorously incorporate DISE-based strict inclusion criteria might be needed to assess the efficacy of different techniques and generalize the findings. |
| first_indexed | 2024-03-11T02:11:04Z |
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| id | doaj.art-2181197f09f64f4c9ec373f432464f32 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T02:11:04Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj.art-2181197f09f64f4c9ec373f432464f322023-11-18T11:32:10ZengMDPI AGMedicina1010-660X1648-91442023-06-01596114710.3390/medicina59061147Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic ReviewAna Maria Vlad0Cristian Dragos Stefanescu1Iemima Stefan2Viorel Zainea3Razvan Hainarosie4“Prof. Dr. Dorin Hociota” Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania“Prof. Dr. Dorin Hociota” Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, RomaniaENT Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania“Prof. Dr. Dorin Hociota” Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania“Prof. Dr. Dorin Hociota” Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania<i>Background</i><b>:</b> In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess soft tissue to less invasive reconstruction techniques that aim to preserve pharyngeal function while effectively managing sleep apnea. This review aims to evaluate and compare the efficacy of the surgical techniques utilized for OSA at the level of the palate and pharynx. It will cover both traditional and novel procedures. <i>Methods:</i> A comprehensive search of the major databases, such as PubMed/MEDLINE, Web of Science, and Scopus, was conducted to identify the relevant literature. We included articles written in English that analyzed the outcomes of adult patients who received velopharyngeal surgery for sleep apnea. Only comparative studies that examined at least two techniques were considered. <i>Results:</i> In all of the studies combined, the total number of patients who underwent velopharyngeal surgery was 614 in eight studies. All surgical procedures resulted in improvements in the apnea–hypopnea index (AHI). The highest success rates and best outcomes were achieved by barbed reposition pharyngoplasty (BRP) in most studies, ranging from 64.29% to 86.6%. BRP also demonstrated the most significant improvements in both objective and subjective parameters closely followed by ESP that obtained similar efficiency in some studies, especially when combined with anterior palatoplasty (AP), but with a higher incidence of complications. While LP showed moderate efficiency compared with BRP or ESP, the UPPP techniques exhibited greater outcome variability among studies, with a success rate ranging from 38.71% to 59.26%, and the best results observed in a multilevel context. <i>Conclusions:</i> In our review, BRP was the most preferred, effective, and safe among all velopharyngeal techniques, closely followed by ESP. However, older described techniques also showed good results in well-selected patients. Larger-scale studies, preferably prospective, that rigorously incorporate DISE-based strict inclusion criteria might be needed to assess the efficacy of different techniques and generalize the findings.https://www.mdpi.com/1648-9144/59/6/1147obstructive sleep apneapalatopharyngeal surgerybarbed reposition pharyngoplastyexpansion sphincter pharyngoplastyuvulopalatopharyngoplasty |
| spellingShingle | Ana Maria Vlad Cristian Dragos Stefanescu Iemima Stefan Viorel Zainea Razvan Hainarosie Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review Medicina obstructive sleep apnea palatopharyngeal surgery barbed reposition pharyngoplasty expansion sphincter pharyngoplasty uvulopalatopharyngoplasty |
| title | Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review |
| title_full | Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review |
| title_fullStr | Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review |
| title_full_unstemmed | Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review |
| title_short | Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review |
| title_sort | comparative efficacy of velopharyngeal surgery techniques for obstructive sleep apnea a systematic review |
| topic | obstructive sleep apnea palatopharyngeal surgery barbed reposition pharyngoplasty expansion sphincter pharyngoplasty uvulopalatopharyngoplasty |
| url | https://www.mdpi.com/1648-9144/59/6/1147 |
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