OSA Treatment: Barbed Reposition and Expansion Sphincter Pharyngoplasties Produce Comparable Outcomes

by Linda Kossoff •

How does barbed reposition pharyngoplasty (BRP) compare with expansion sphincter pharyngoplasty (ESP) in the treatment of obstructive sleep apnea (OSA)?

BOTTOM LINE

BRP and ESP procedure outcomes are comparable in the improvement of OSA with palatal collapse, although further trials and long-term follow-up are needed.

BACKGROUND: In OSA treatment, when conservative options fail, surgery is an alternative. The oropharyngeal region is believed to be the most common site of airway obstruction, with lateral pharyngeal wall collapse as the determining factor. The most commonly used surgical procedures to target the pharyngeal wall are BRP and ESP.

STUDY DESIGN: Systematic review.

SETTING: Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.

SYNOPSIS: In a database search, researchers identified four studies with 208 total participants who met their review criteria, which included sleep apnea or sleep disorder, intervention of BRP or ESP, and comparison of BRP and ESP. The BRP group had 103 participants, median age 42.8 years; the ESP group had 105 participants, median age 47.2 years. Most participants were male (68.9%) and overweight on average, with moderate to severe OSA. A meta-analysis of the data showed similar success rates between the two procedures (84.96% and 79.87% BRP and ESP, respectively). The mean reduction of apnea–

hypopnea index (AHI) for BRP and ESP were 74.03% and 60.17%, respectively. No significant differences were found between the groups regarding change in AHI, postoperative AHI, postoperative sleepiness, pain, hospital stay, time to oral diet, and change in oxygen desaturation index. Overall, researchers found no significant difference between BRP and ESP surgical outcomes in multiple respects; however, the operative time was 21.7 minutes less in the BRP group, and this group also required less analgesic. Limitations of the meta-analysis included the heterogeneity between the studies and a small sample size.

CITATION: Neruntarat C, Khuancharee K, Saengthong P. Barbed reposition pharyngoplasty versus expansion sphincter pharyngoplasty: A meta-analysis. Laryngoscope. 2021;131:1420-1428.