Efficacy, predictors of success and failure of an updated lateral pharyngoplasty approach as an independent procedure in treating obstructive sleep apnea with CPAP failures

Purpose: To assess predictors of success and failure of an updated lateral pharyngoplasty as an independent procedure in treating obstructive sleep apnea with CPAP failures.

Methods: Forty-six patients with known OSAS who were resistant to CPAP or failures were included. BMI, Stop-Bang score, and sleep study data were recorded before and after the updated Cahali pharyngoplasty procedure. Pre-operative DISE was done for all cases; however, postoperative DISE was done only for non-responders.

Results: Successful operation outcomes achieved in 69.6% (32 cases) and 30.4% (14 cases) were failure rates. Postoperative snoring index, Stop Bang score, and AHI were significantly decreased compared to pre-operative data (p value < 0.001). There is statistically a significant increase in minimal and baseline SpO₂ postoperatively (p value < 0.001). Patients with no laryngeal collapse (L0) predict operation success. However, patients with high pre-operative snoring index, collapse at lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, and low grades tonsils (1, 2) predict the failure of the surgery (p value = 0.006*,0.024*,0.047*, respectively).

Conclusion: Updated Cahali lateral pharyngoplasty could not be used as an independent procedure in all OSA patients. The lack of laryngeal collapse (L0) is a considerable success predictor for the procedure. However, the pre-operative low-grade tonsils (1, 2) and high snoring index predict operation failure.