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Modified expansion sphincter pharyngoplasty for treatment of children with obstructive sleep apnea
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas2Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, Texas.
Insights
Modified expansion sphincter pharyngoplasty (ESP) effectively treats severe obstructive sleep apnea (OSA) in children with lateral pharyngeal wall collapse. This surgical approach shows superior outcomes compared to tonsillectomy and adenoidectomy for improving OSA severity.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Lateral pharyngeal wall collapse is a key factor in obstructive sleep apnea (OSA) pathogenesis.
- Severe OSA in children necessitates effective surgical interventions.
- Modified expansion sphincter pharyngoplasty (ESP) is a potential treatment for OSA.
Purpose of the Study:
- To evaluate the efficacy of a modified expansion sphincter pharyngoplasty (ESP) in treating pediatric obstructive sleep apnea (OSA) specifically in cases of lateral pharyngeal muscle wall collapse.
- To compare the outcomes of modified ESP with tonsillectomy and adenoidectomy (TA) in children with severe OSA.
Main Methods:
- Retrospective review of medical records for children diagnosed with OSA and lateral pharyngeal muscle wall collapse.
- Comparison between patients who underwent modified ESP and those who had tonsillectomy and adenoidectomy (TA) between 2008 and 2013.
- Primary outcome: cure rate defined by apnea-hypopnea index (AHI) < 1. Secondary outcomes: pre- and postoperative AHI, minimum oxygen saturation, and time with saturation < 90%.
Main Results:
- The modified ESP group (n=25) showed a significantly lower mean postoperative AHI (2.4) compared to the TA group (n=25) (6.2) (P < .001).
- Cure rates (AHI <1) were substantially higher for modified ESP (64%) versus TA (8%).
- Higher cure rates were observed for modified ESP across all AHI thresholds (<2: 72% vs 44%; <5: 80% vs 60%).
Conclusions:
- Modified expansion sphincter pharyngoplasty (ESP) offers significant objective clinical improvement for children with severe OSA and lateral pharyngeal wall collapse.
- This procedure presents a viable and effective alternative to tonsillectomy and adenoidectomy (TA) for managing pediatric OSA.
- The findings support considering modified ESP as a primary surgical option for specific pediatric OSA cases.
Importance:
Lateral pharyngeal wall collapse has been implicated in the pathogenesis of obstructive sleep apnea (OSA). Modified expansion sphincter pharyngoplasty (ESP) is a simple procedure and can be considered in the surgical management of children with severe OSA.
Objective:
To describe a modified ESP addressing lateral pharyngeal muscle wall collapse in the treatment of children with OSA.
Design, Setting, And Participants:
Retrospective review of the medical records of children with OSA and lateral pharyngeal muscle wall collapse who underwent modified ESP and children who had tonsillectomy and adenoidectomy (TA) for OSA between 2008 and 2013 at a tertiary care children's hospital.
Interventions:
Modified ESP.
Main Outcomes And Measures:
The primary outcome measure was the rate of cure, which was defined as an apnea-hypopnea index (AHI) lower than 1. Other outcomes were differences in preoperative and postoperative AHI, minimum saturation of peripheral oxygen, and percentage of total sleep study time with oxygen saturation less than 90%.
Results:
Twenty-five children who had modified ESP and 25 AHI-matched children who had TA for severe OSA were identified. The postoperative AHI was lower than the preoperative AHI in both groups. Preoperative AHI was similar between modified ESP and TA groups. The mean (SD) postoperative AHI of the modified ESP group (2.4 [3.9]) was lower than that of the TA group (6.2 [6.0]) (P < .001). Cure rates for the modified ESP group (AHI <1, 64%; AHI <2, 72%; and AHI <5, 80%) were greater than those for the TA group (AHI <1, 8%; AHI <2, 44%; and AHI <5, 60%).
Conclusions And Relevance:
Modified ESP provided objective clinical improvement of OSA in children with severe OSA and lateral pharyngeal wall collapse and might serve as an effective alternative to TA for treatment of OSA.
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