Posterior Pillar Hypertrophy as a Novel Anatomical Predictor of Surgical Success in Obstructive Sleep Apnea

Sleep apnea surgery is effective only in appropriately selected patients, making accurate identification of candidates essential. This study aimed to introduce a novel anatomical index for identifying patients most likely to achieve favorable surgical outcomes.

A retrospective review was performed on patients with obstructive sleep apnea who underwent multilevel surgery by a single surgeon at a tertiary medical center between 2012 and 2021. Anatomical parameters, endoscopic images, and pre- and postoperative polysomnography findings were analyzed. Some patients exhibited posterior pillar hypertrophy (PPH), characterized by thickening of the palatopharyngeal muscle beyond normal dimensions. To evaluate the exclusive effects of PPH, patients were randomly selected and subjected to propensity score matching.

Logistic regression analysis identified tonsil grade, body mass index, and posterior pillar thickness as significant predictors of surgical success. Success rates differed significantly between the PPH(+) and PPH(-) groups, with 51.9% success in the PPH(+) group compared to 40.7% in the PPH(-) group. Moreover, the PPH(+) group demonstrated a significantly greater postoperative improvement in both the apnea-hypopnea index and oxygen desaturation index.

The presence of PPH represents an important anatomical predictor of surgical success in the treatment of obstructive sleep apnea. This index facilitates more precise patient selection and surgical planning, potentially improving overall treatment outcomes.