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Sleep Medicine

(340) Novel predictor for sleep surgery outcome: posterior pillar hypertrophy

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

    Co-Author(s)

  • YJ

    Yeonsu Jeong, MD

    YONSEI UNIVERSITY COLLEGE OF MEDICINE
    Seoul, United States

  • Chang-Hoon Kim, MD, PhD

    Professor
    Yonsei University College of Medicine
    Seoul, Republic of Korea

    • Presenting Author(s)

  • Hyung-Ju Cho, MD

    Professor
    YONSEI UNIVERSITY COLLEGE OF MEDICINE
    SEOUL, Seoul-t'ukpyolsi, Republic of Korea

    • Senior Author(s)

  • Hyung-Ju Cho, MD

    Professor
    YONSEI UNIVERSITY COLLEGE OF MEDICINE
    SEOUL, Seoul-t'ukpyolsi, Republic of Korea

Disclosure(s):
Chang-Hoon Kim, MD, PhD: No relevant relationships to disclose.
Hyung-Ju Cho, MD: No relevant relationships to disclose.


Introduction: Since sleep apnea surgery is only effective for certain patients, finding a surgical responder is very important. This study aims to present a new anatomical index that can select patients with favorable surgical outcomes

Methods: This study is a retrospective review for analyzing the treatment effects of patients who were diagnosed with obstructive sleep apnea and underwent multilevel surgery by a single surgeon at the tertiary medical institution from 2012 to 2021. Patient anatomical parameters, endoscopic images, and preoperative/postoperative polysomnography reports were used for analysis.
In some patients, the palatopharyngeal muscle, which forms the posterior pillar, is more thicker than normal. These patients were assessed as having posterior pillar hypertrophy and described along with other anatomical indices.
To evaluate only the effects of posterior pillar hypertrophy, patients who met the conditions were randomly selected and propensity matching was performed.

Results: Logistic regression analysis was performed to find anatomical indicators that determine the success of the surgery. As a result of the analysis, Tonsil grade, BMI, and posterior pillar thickness were identified as statistically significant indicators to evaluate the success of the surgery.
There was a difference in the success rate of surgery in the two groups (after propensity matching, posterior pillar hypertrophy group: PPH(+) and normal control group: PPH(-) was made). The percentage of patients with surgical success in the PPH(-) group was 40.7%, which was higher at 51.9% in the PPH(+) group. Furthermore, the improvement in AHI and ODI after surgery was statistically significantly higher in the PPH(+) group.

Conclusions: The presence or absence of posterior pillar hypertrophy is an indicator that can be used to predict the effectiveness of surgical treatment in patients with obstructive sleep apnea, and can be used as a basis for selection of patients and surgical methods.