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Anxiety, depression and sleepiness in OSA patients treated with barbed reposition pharyngoplasty: a prospective study

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Abstract

Purpose

To evaluate the efficacy of barbed reposition pharyngoplasty (BRP) on sleepiness, anxiety, and depression o adult patients with obstructive sleep apnea (OSA).

Methods

We performed a prospective multicentric study to assess functional outcomes in 20 OSA patients treated with BRP and compare the results with an observational group of 20 subjects. All recruited subjects performed at baseline and 6-months postoperative follow-up Polysomnography (PSG), daytime sleepiness scoring using the Epworth Sleepiness Scale (ESS), and anxiety and depression evaluation via the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) questionnaires.

Results

At follow-up the BRP demonstrated greater improvements in AHI (8.92 ± 2.29 vs. 30.66 ± 2.56; p < 0.001) and ODI (7.65 ± 2.39 vs. 24.55 ± 3.20; p < 0.001) than control at intergroup analysis. Surgical group reported significant data in daytime sleepiness (5.15 ± 1.19 vs. 13.15 ± 1.35; p < 0.001), anxiety (12.65 ± 3.11 vs. 24.2 ± 2.37; p < 0.001), and depression domains (5.85 ± 1.19 vs. 17.55 ± 3.24; p < 0.001). AHI, ODI, and advanced age have been shown to multiple regression as independent predictors of treatment response for mood domains (p < 0.001; p = 0.02; p = 0.041, respectively).

Conclusions

Patients with OSA may benefit from palate surgery, reducing not only the apnea and hypopnea index, daytime sleepiness but also associated mood comorbidities. However, further studies are needed to confirm our preliminary results to validate the evidence to date reported.

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References

  1. Kapur VK, Auckley DH, Chowdhuri S et al (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 13(3):479–504. https://doi.org/10.5664/jcsm.6506 (Published 2017 Mar 15)

    Article  PubMed  PubMed Central  Google Scholar 

  2. Iannella G, Maniaci A, Magliulo G et al (2020) Current challenges in the diagnosis and treatment of obstructive sleep apnea syndrome in the elderly. Pol Arch Intern Med 130(7–8):649–654. https://doi.org/10.20452/pamw.15283

    Article  PubMed  Google Scholar 

  3. Rana D, Torrilus C, Ahmad W, Okam NA, Fatima T, Jahan N (2020) Obstructive sleep apnea and cardiovascular morbidities: a review article. Cureus 12(9):e10424. https://doi.org/10.7759/cureus.10424 (Published 2020 Sep 13)

    Article  PubMed  PubMed Central  Google Scholar 

  4. Iannella G, Vicini C, Colizza A et al (2019) Aging effect on sleepiness and apneas severity in patients with obstructive sleep apnea syndrome: a meta-analysis study. Eur Arch Otorhinolaryngol 276(12):3549–3556. https://doi.org/10.1007/s00405-019-05616-0

    Article  PubMed  Google Scholar 

  5. Vicini C, De Vito A, Iannella G et al (2018) The aging effect on upper airways collapse of patients with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 275(12):2983–2990. https://doi.org/10.1007/s00405-018-5163-5

    Article  PubMed  Google Scholar 

  6. Iannella G, Magliulo G, Maniaci A, Meccariello G, Cocuzza S, Cammaroto G, Gobbi R, Sgarzani R, Firinu E, Corso RM, Pace A, Gulotta G, Visconti IC, Di Luca M, Pelucchi S, Bianchi G, Melegatti M, Abita P, Solito C, La Mantia I, Grillo C, Vicini C (2021) Olfactory function in patients with obstructive sleep apnea: a meta-analysis study. Eur Arch Otorhinolaryngol 278(3):883–891. https://doi.org/10.1007/s00405-020-06316-w (Epub 2020 Sep 10 PMID: 32914257)

    Article  PubMed  Google Scholar 

  7. May AM, Van Wagoner DR, Mehra R (2017) OSA and cardiac arrhythmogenesis: mechanistic insights. Chest 151(1):225–241. https://doi.org/10.1016/j.chest.2016.09.014

    Article  PubMed  Google Scholar 

  8. Pace A, Iannella G, Rossetti V et al (2020) Diagnosis of obstructive sleep apnea in patients with allergic and non-allergic rhinitis. Medicina (Kaunas) 56(9):454. https://doi.org/10.3390/medicina56090454 (Published 2020 Sep 8)

    Article  Google Scholar 

  9. Pollicina I, Maniaci A, Lechien JR, Iannella G, Vicini C, Cammaroto G, Cannavicci A, Magliulo G, Pace A, Cocuzza S, Di Luca M, Stilo G, Di Mauro P, Bianco MR, Murabito P, Bannò V, La Mantia I (2021) Neurocognitive performance improvement after obstructive sleep apnea treatment: state of the art. Behav Sci (Basel) 11(12):180

    Article  Google Scholar 

  10. Althoff MD, Ghincea A, Wood LG, Holguin F, Sharma S (2021) Asthma and three colinear comorbidities: obesity, OSA, and GERD. J Allergy Clin Immunol Pract 9(11):3877–3884. https://doi.org/10.1016/j.jaip.2021.09.003

    Article  PubMed  Google Scholar 

  11. Reutrakul S, Mokhlesi B (2017) Obstructive sleep apnea and diabetes: a state of the art review. Chest 152(5):1070–1086. https://doi.org/10.1016/j.chest.2017.05.009

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hobzova M, Prasko J, Vanek J et al (2017) Depression and obstructive sleep apnea. Neuroendocrinol Lett 38:343–352

    CAS  PubMed  Google Scholar 

  13. Aloia MS, Arnedt JT, Smith L et al (2005) Examining the construct of depression in obstructive sleep apnea syndrome. Sleep Med 6(2):115–121. https://doi.org/10.1016/j.sleep.2004.09.003

    Article  PubMed  Google Scholar 

  14. Dalmases M, Solé-Padullés C, Torres M et al (2015) Effect of CPAP on cognition, brain function, and structure among elderly patients with OSA: a randomized pilot study. Chest 148(5):1214–1223. https://doi.org/10.1378/chest.15-0171

    Article  PubMed  Google Scholar 

  15. Zheng D, Xu Y, You S et al (2019) Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular endpoint randomised trial and meta-analysis. EClinicalMedicine 11:89–96

    Article  Google Scholar 

  16. Ponce S, Pastor E, Orosa B et al (2019) The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: a multicentre randomised controlled trial. Eur Respir J 54(2):1900518. https://doi.org/10.1183/13993003.00518-2019 (Published 2019 Aug 22)

    Article  CAS  PubMed  Google Scholar 

  17. Campos-Rodriguez F, Queipo-Corona C, Carmona-Bernal C et al (2016) Continuous positive airway pressure improves quality of life in women with obstructive sleep apnea. A randomized controlled trial. Am J Respir Crit Care Med 194(10):1286–1294

    Article  Google Scholar 

  18. Labarca G, Saavedra D, Dreyse J, Jorquera J, Barbe F (2020) Efficacy of CPAP for improvements in sleepiness, cognition, mood, and quality of life in elderly patients with OSA: systematic review and meta-analysis of randomized controlled trials. Chest 158(2):751–764. https://doi.org/10.1016/j.chest.2020.03.049

    Article  PubMed  Google Scholar 

  19. Wang Y, Gao W, Sun M, Chen B (2012) Adherence to CPAP in patients with obstructive sleep apnea in a Chinese population. Respir Care 57(2):238–243. https://doi.org/10.4187/respcare.01136

    Article  PubMed  Google Scholar 

  20. Avellan-Hietanen H, Maasilta P, Bachour A (2020) Restarting CPAP therapy for sleep apnea after a previous failure. Respir Care 65(10):1541–1546. https://doi.org/10.4187/respcare.07766

    Article  PubMed  Google Scholar 

  21. Iannella G, Magliulo G, Di Luca M, De Vito A, Meccariello G, Cammaroto G, Pelucchi S, Bonsembiante A, Maniaci A, Vicini C (2020) Lateral pharyngoplasty techniques for obstructive sleep apnea syndrome: a comparative experimental stress test of two different techniques. Eur Arch Otorhinolaryngol 277(6):1793–1800

    Article  Google Scholar 

  22. Iannella G, Magliulo G, Cammaroto G, Meccariello G, De Vito A, Pelucchi S, Ciorba A, Maniaci A, Cocuzza S, Gulotta G, Pace A, Corso RM, Bahgat A, Vicini C (2021) Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial. Sleep Breath. https://doi.org/10.1007/s11325-021-02528-4

    Article  PubMed  Google Scholar 

  23. von Elm E, Altman DG, Egger M et al (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 12(12):1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013

    Article  Google Scholar 

  24. Xie HS, Chen GP, Huang JF et al (2021) Impact of upper airway configuration on CPAP titration assessed by CT during Müller’s maneuver in OSA patients. Respir Physiol Neurobiol 284:103559. https://doi.org/10.1016/j.resp.2020.103559

    Article  PubMed  Google Scholar 

  25. Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268(8):1233–1236. https://doi.org/10.1007/s00405-011-1633-8

    Article  PubMed  Google Scholar 

  26. Fydrich T, Dowdall D, Chambless DL (1993) Reliability and validity of the Beck Anxiety Inventory. J Anx Disord 6:55–61

    Article  Google Scholar 

  27. Wang YP, Gorenstein C (2013) Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psychiatry 35(4):416–431. https://doi.org/10.1590/1516-4446-2012-1048

    Article  PubMed  Google Scholar 

  28. Iannella G, Lechien JR, Perrone T et al (2022) Barbed reposition pharyngoplasty (BRP) in obstructive sleep apnea treatment: State of the art. Am J Otolaryngol 43(1):103197. https://doi.org/10.1016/j.amjoto.2021.103197

    Article  PubMed  Google Scholar 

  29. Chiu HY, Chen PY, Chuang LP et al (2017) Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 36:57–70. https://doi.org/10.1016/j.smrv.2016.10.004

    Article  PubMed  Google Scholar 

  30. Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19(2):156–177. https://doi.org/10.1093/sleep/19.2.156

    Article  CAS  PubMed  Google Scholar 

  31. Vicini C, Meccariello G, Montevecchi F et al (2020) Effectiveness of barbed repositioning pharyngoplasty for the treatment of obstructive sleep apnea (OSA): a prospective randomized trial. Sleep Breath 24(2):687–694. https://doi.org/10.1007/s11325-019-01956-7

    Article  PubMed  Google Scholar 

  32. Pang KP, Vicini C, Montevecchi F et al (2020) Long-term complications of palate surgery: a multicenter study of 217 patients. Laryngoscope 130(9):2281–2284. https://doi.org/10.1002/lary.28432

    Article  PubMed  Google Scholar 

  33. Gulotta G, Iannella G, Meccariello G et al (2021) Barbed suture Extrusion and Exposure in palatoplasty for OSA: What does it mean? Am J Otolaryngol 42(4):102994. https://doi.org/10.1016/j.amjoto.2021.102994

    Article  PubMed  Google Scholar 

  34. Maniaci A, Di Luca M, Lechien JR, Iannella G, Grillo C, Grillo CM, Merlino F, Calvo-Henriquez C, De Vito A, Magliulo G, Pace A, Vicini C, Cocuzza S, Bannò V, Pollicina I, Stilo G, Bianchi A, La Mantia I (2022) Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis. Sleep Breath. https://doi.org/10.1007/s11325-021-02520-y

    Article  PubMed  Google Scholar 

  35. Rashwan MS, Montevecchi F, Firinua E et al (2018) Let’s know from our patients: PPOPS score for palate surgery evaluation/a pilot study. Eur Arch Otorhinolaryngol 275(1):287–291. https://doi.org/10.1007/s00405-017-4795-1

    Article  PubMed  Google Scholar 

  36. Lin HC, Lee CY, Friedman M et al (2018) Effects of minimally invasive surgery for patients with OSA on quality of life. Ann Otol Rhinol Laryngol 127(2):118–123. https://doi.org/10.1177/0003489417750164

    Article  PubMed  Google Scholar 

  37. Quintana-Gallego E, Carmona-Bernal C, Capote F et al (2004) Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 98(10):984–989

    Article  Google Scholar 

  38. Pillar G, Lavie P (1998) Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index. Chest 114(3):697–703

    Article  CAS  Google Scholar 

  39. Smith R, Ronald J, Delaive K et al (2002) What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest 121(1):164–172

    Article  Google Scholar 

  40. Shepertycky MR, Banno K, Kryger MH (2005) Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 28(3):309–314

    PubMed  Google Scholar 

  41. Ishman SL, Benke JR, Cohen AP, Stephen MJ, Ishii LE, Gourin CG (2014) Does surgery for obstructive sleep apnea improve depression and sleepiness? Laryngoscope 124(12):2829–2836. https://doi.org/10.1002/lary.24729

    Article  PubMed  Google Scholar 

  42. Burlon G, Tepedino M, Laurenziello M et al (2020) Evaluation of factors that influence the success rate of OSA treatment with a customised adjustable MAD device - a retrospective study. Acta Otorhinolaryngol Ital 40(4):297–303. https://doi.org/10.14639/0392-100X-N0307

    Article  PubMed  PubMed Central  Google Scholar 

  43. Evans SS, Richman J, Cho DY, Withrow K (2020) Increasing preoperative apnea severity improves upper airway stimulation response in OSA treatment. Laryngoscope 130(2):556–560. https://doi.org/10.1002/lary.28009

    Article  PubMed  Google Scholar 

  44. Petri N, Christensen IJ, Svanholt P, Sonnesen L, Wildschiødtz G, Berg S (2019) Mandibular advancement device therapy for obstructive sleep apnea: a prospective study on predictors of treatment success. Sleep Med 54:187–194. https://doi.org/10.1016/j.sleep.2018.09.033

    Article  PubMed  Google Scholar 

  45. Bakker JP, O’Keeffe KM, Neill AM, Campbell AJ (2014) Continuous positive airway pressure treatment for obstructive sleep apnoea: Maori, Pacific and New Zealand European experiences. J Prim Health Care 6(3):221–228 (Published 2014 Sep 1)

    Article  Google Scholar 

  46. Elsobki A, Moussa HH, Eldeeb ME, Fayed A, Elzayat S (2022) Efficacy, predictors of success and failure of an updated lateral pharyngoplasty approach as an independent procedure in treating obstructive sleep apnea with CPAP failures. Eur Arch Otorhinolaryngol 279(2):945–953. https://doi.org/10.1007/s00405-021-06825-2

    Article  PubMed  Google Scholar 

  47. Shie DY, Tsou YA, Tai CJ, Tsai MH (2013) Impact of obesity on uvulopalatopharyngoplasty success in patients with severe obstructive sleep apnea: a retrospective single-center study in Taiwan. Acta Otolaryngol 133(3):261–269. https://doi.org/10.3109/00016489.2012.741328

    Article  PubMed  Google Scholar 

  48. Vroegop AV, Vanderveken OM, Boudewyns AN et al (2014) Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1249 cases. Laryngoscope 124(3):797–802. https://doi.org/10.1002/lary.24479

    Article  PubMed  Google Scholar 

  49. Ravesloot MJ, de Vries N (2011) One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 121(12):2710–2716. https://doi.org/10.1002/lary.22369

    Article  PubMed  Google Scholar 

  50. Martínez-Ruíz de Apodaca P, Carrasco-Llatas M, Matarredona-Quiles S, Valenzuela-Gras M, Dalmau-Galofre J (2022) Long-term stability of results following surgery for obstructive sleep apnea (OSA). Eur Arch Otorhinolaryngol 279(1):373–380. https://doi.org/10.1007/s00405-021-06781-x

    Article  PubMed  Google Scholar 

  51. Friberg D, Sundman J, Browaldh N (2020) Long-term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty. Laryngoscope 130(1):263–268. https://doi.org/10.1002/lary.27917

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy

    Antonino Maniaci, Salvatore Ferlito, Milena Di Luca, Isabella Pollicina, Giovanna Stilo & Paola Di Mauro

  2. Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France

    Antonino Maniaci, Jerome Rene Lechien & Giovanni Cammaroto

  3. Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium

    Jerome Rene Lechien

  4. Department of Sensory Organs, “Sapienza” University of Rome, 00100, Rome, Italy

    Giannicola Iannella, Giuseppe Magliulo & Annalisa Pace

  5. Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forli, Italy

    Giovanni Cammaroto, Angelo Cannavicci & Claudio Vicini

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  1. Antonino Maniaci
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  2. Salvatore Ferlito
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  3. Jerome Rene Lechien
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  11. Giuseppe Magliulo
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  12. Annalisa Pace
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  13. Claudio Vicini
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Correspondence to Antonino Maniaci.

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Maniaci, A., Ferlito, S., Lechien, J.R. et al. Anxiety, depression and sleepiness in OSA patients treated with barbed reposition pharyngoplasty: a prospective study. Eur Arch Otorhinolaryngol 279, 4189–4198 (2022). https://doi.org/10.1007/s00405-022-07369-9

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