Is barbed pharyngoplasty a suitable alternative to CPAP in OSA elderly patients?

Barbed Pharyngoplasty (BP), a minimally invasive, muscle-preserving surgical technique utilizing Barbed Sutures (BS) for palatal suspension and remodelling, has shown efficacy in younger cohorts but remains underexplored in older adults. The aim of this study was to show the effectiveness and safety of the BP technique as a standalone surgical treatment in selected elderly patients with moderate-severe OSA and concentric pharyngeal collapse non-compliant, intolerant, or refractory to CPAP.

A retrospective study was conducted on 17 patients aged ≥ 65 years (older group) and 23 patients aged < 65 years (younger group) who underwent BP. Pre- and postoperative assessments included Apnea-Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), Epworth Sleepiness Scale (ESS), and snoring severity via bed partner Visual Analog Scale (VAS).

In the older group, the mean AHI significantly decreased from 39.9 ± 20.1 to 21.1 ± 14.4 events/hour (p = 0.0002), and ODI from 32.6 ± 21.8 to 17.8 ± 12.5 events/hour (p = 0.002). Postoperative ESS and VAS scores also demonstrated significant improvement (14 ± 6.4 to 6.0 ± 3.2, and 7.9 ± 2.9 to 3.4 ± 1.5, respectively; p < 0.05). Surgical success was achieved in 42% of older group compared to 78% in the younger group. No major complications were observed.

BP is a viable, safe, and effective surgical option for selected elderly patients with moderate-to-severe OSA who are non-adherent to CPAP therapy are. Although its success rate is lower than in younger populations, likely due to age-related anatomical changes, BP provides clinically significant improvements in respiratory function and symptoms.