Challenging barriers in OSA: Outcomes of "Down under" pharyngoplasty and coblation tongue channelling

PURPOSE: Obstructive sleep apnoea (OSA) is a growing health concern with significant personal and public health costs. This is the first study to evaluate the efficacy of “Down Under” barbed reposition pharyngoplasty (DU-BRP) and coblation tongue channelling (CCT) in adults with OSA, particularly those with unfavourable anatomical phenotypes. METHODS: A prospective, two-centre cohort trial was conducted with 105 patients undergoing DU-BRP and CCT. Outcomes included Apnoea-Hypopnoea Index (AHI), Oxygen Desaturation Index (ODI4%), Epworth Sleepiness Scale (ESS), and changes in upper airway anatomy, measured pre- and 3–6 months post-operatively. RESULTS: Of the 105 patients, 92 attended all postoperative appointments and 75 completed postoperative polysomnography and were included in the objective outcome analysis. The cohort (68/92 male, mean age 40.6 ± 12.7 years) showed significant improvement across all measures. Median (IQR) AHI decreased from 27 (33.4) to 7.1 (11.6) events/hr (p < 0.001), ESS from 12.5 (8) to 4 (4) points (p < 0.001), and ODI4% from 25.4 (37) to 7 (17) (p < 0.001). Surgical success (AHI < 20 with > 50% reduction) was achieved in 75% of patients, with 43% considered complete responders (AHI < 5). Among patients with challenging anatomy, success rates were 76% for those with Friedman stage 3 anatomy, 62.5% for those with complete circumferential velum collapse, and 73% for those with complete base of tongue collapse. CONCLUSION: DU-BRP combined with CCT was associated with significant improvements in objective and patient-reported OSA outcomes at six months, including in patients with unfavourable anatomical phenotypes. Future research should refine staging systems incorporating physiologic phenotypes to enhance the predictability of outcomes of these surgical techniques.