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Sleep Medicine

(527) Upper Airway Collapsibility and Maxillary Expansion Outcomes: A Preliminary Analysis

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • MP

    Manan H. Parekh, BA

    Student
    Penn Medicine
    Philadelhpia, Pennsylvania, United States

    • Co-Author(s)

  • Eric Thuler, MD, PhD

    Postdoctoral Researcher
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • Akshay Tangutur, MS

    Medical Student
    Penn Otorhinolaryngology
    Pacific Palisades, California, United States

  • ES

    Everett G. Seay, BS, RPSGT

    Research Program Manager
    Division of Sleep Surgery, Penn Otorhinolaryngology
    Philadelphia, PA, United States

  • AS

    Alan R. Schwartz, MD

    Adjunct Professor; Part-time faculty
    University of Pennsylvania
    BALTIMORE, Maryland, United States

    • Senior Author(s)

  • Raj C. C. Dedhia, MD, MSCR

    Associate Professor of Otorhinolaryngology & Medicine
    Division of Sleep Surgery, Penn Otorhinolaryngology
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Manan H. Parekh, BA: No relevant relationships to disclose.
Eric Thuler, MD, PhD: No relevant relationships to disclose.
Akshay Tangutur, MS: No relevant relationships to disclose.
Alan R. Schwartz, MD: No relevant relationships to disclose.


Introduction: Surgically-assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a contributing factor to obstructive sleep apnea (OSA). Titrating positive airway pressure during drug-included sleep endoscopy (DISE-PAP) enables quantitative measures of upper airway collapsibility. Herein, we analyzed the relationship between metrics of collapsibility and SARPE outcomes.

Methods: This cohort study included adult OSA patients with transverse maxillary deficiency that underwent SARPE procedure from January 2021 to September 2022. DISE-PAP titration was performed preoperatively to determine the pressure at which (1) inspiratory airflow first commenced (active critical opening pressure, PCRIT) and (2) inspiratory flow limitation was abolished (pharyngeal opening pressure, PhOP). All patients included had pre- and post-operative sleep studies. Univariate linear regression was used to compare collapsibility measures and post-operative AHI reduction.

Results: Overall, the cohort (N=12) was middle-aged (41.9+/-10.8yrs), male (83%), overweight (BMI 29.2+/-3.0kg/m2), and had moderate-severe OSA (AHI 29.7+/-21.9 events/hr). The mean reduction in AHI after SARPE procedure was 4.0+/-11.3 events/hr (p=0.26). Mean PhOP and PCRIT were 8.75+/-4.5 cm H2O and 1.0+/-2.8 cm H2O, respectively. Lower PhOP values suggested greater AHI reduction after SARPE (beta=-1.45 95%CI [-3.0,0.08], p=0.062) while active PCRIT values did not impact AHI reduction (beta=0.69 95%CI [-2.19,3.57], p=0.59).

Conclusions: While statistically non-significant in our small sample, our novel analysis suggests a relationship between low PhOP values and better outcome after SARPE. These analyses suggest patients with lower DISE-PhOP values may be optimal candidates for SARPE. We aim to further explore this potential association with a larger sample and investigate other influences on SARPE outcomes.