Surgical Treatment of Obstructive Sleep Apnea Syndrome in Patients with Bilateral Vocal Fold Paralysis

Background: Systematic among patients with bilateral vocal fold paralysis (BVFP), the most clinically significant symptom is dyspnea, which often requires surgical intervention. One of the most common causes of BVFP is iatrogenic injury during thyroidectomy. Some patients report not only day time breathing difficulties but also a deterioration in sleep quality since the onset of BVFP. Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder caused by recurrent upper airway obstruction during sleep. Although it is usually associated with pharyngeal collapse, fixed laryngeal obstruction has also been suggested as a potential contributor to sleep-disordered breathing. Therefore, we aimed to assess the impact of surgical treatment of OSA in patients with BVFP. Methods: Between 2022 and 2025, 18 patients with BVFP were screened. Patients who met diagnostic criteria for OSA based on preoperative polysomnography (PSG) and the Epworth Sleepiness Scale (ESS) AHI ≥ 15 events/h or AHI ≥ 5 events/h with associated symptoms were included in the study. Five female patients met the criteria and underwent arytenoidectomy combined with posterior cordectomy. A follow-up PSG and re-evaluation of ESS were performed 6-12 months after surgery, and patients were asked about their subjective perception of sleep quality improvement. Results: An improvement in sleep quality, decrease in the median ESS score and respiratory parameters showed an improvement, although this was not statistically significant due to the small sample size (n = 5). Conclusions: These results indicate a positive postoperative trend in sleep quality among patients with BVFP however, given the limited sample size, further studies are required to confirm these observations.