Skip to main content
SpringerLink
Log in

Uvulopalatopharyngoplasty with and without modified thyrohyoid suspension for obstructive sleep apnea treatment: a randomized clinical trial

  • Miscellaneous
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

This study aims to compare the efficacy of Uvulopalatopharyngoplasty + Tongue Base Radiofrequency (TB-RF) and Uvulopalatopharyngoplasty + modified thyrohyoid suspension techniques + TB-RF which aimed to suspend base of tongue muscles anteriorly toward thyroid cartilage.

Methods

This randomized controlled trial study was conducted on 48 cases of confirmed OSA between Jan, 2019 and Aug, 2022. We divided patients into two groups. One group underwent Uvulopalatopharyngoplasty + modified thyrohyoid suspension + TB-RF technique, and another one underwent Uvulopalatopharyngoplasty + TB-RF. Then, Apnea–Hypopnea Index (AHI), mean and lowest O2 saturation, Drug-Induced Sleep Endoscopy (DISE), Epworth Sleepiness Scale (ESS), Digit Symbol Substitution Test (DSST), Stanford Subjective Snoring Scale (SSSS), and T90 indexes were evaluated before and after each surgery.

Results

The mean ± SD age was 39.4 ± 11.17 years. Of the 48 patients, 79.1% (n = 33) were male and 20.9% (n = 15) were female. AHI and SSSS in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group were significantly better than Uvulopalatopharyngoplasty group (P-value; 0.010). Though, there was no significant difference in terms of mean saturation, lowest desaturation, ESS, DSST, and T90 scores. The success rate in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension and Uvulopalatopharyngoplasty groups, according to the Sher criteria: a minimum of 50% reduction with a final AHI less than 20, were 75% (18/24) and 41.7% (10/24), respectively. It was significantly higher in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group (P-value: 0.021).

Conclusion

The addition of modified thyrohyoid suspension technique to Uvulopalatopharyngoplasty have better surgical outcomes and more success rate than Uvulopalatopharyngoplasty in OSA patients.

Trial registration: IRCT: IRCT20190602043791N2. https://en.irct.ir/trial/53365.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The corresponding author can provide access to the data supporting the findings of this study upon request.

References

  1. Diamanti C, Manali E, Ginieri-Coccossis M, Vougas K, Cholidou K, Markozannes E et al (2013) Depression, physical activity, energy consumption, and quality of life in OSA patients before and after CPAP treatment. Sleep Breath 17(4):1159–1168

    Article  CAS  PubMed  Google Scholar 

  2. Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT, Punjabi NM, Quan SF et al (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 122(4):352–360

    Article  PubMed  PubMed Central  Google Scholar 

  3. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE et al (2010) Obstructive sleep apnea–hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182(2):269–277

    Article  PubMed  PubMed Central  Google Scholar 

  4. Almendros I, Basoglu ÖK, Conde SV, Liguori C, Saaresranta T (2022) Metabolic dysfunction in OSA: is there something new under the sun? J Sleep Res 31(1):e13418

    Article  PubMed  Google Scholar 

  5. Mashaqi S, Gozal D (2020) The impact of obstructive sleep apnea and PAP therapy on all-cause and cardiovascular mortality based on age and gender—a literature review. Respir Investig 58(1):7–20

    Article  PubMed  Google Scholar 

  6. Sundman J, Browaldh N, Fehrm J, Friberg D (2021) Eight-year follow-up of modified uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Laryngoscope 131(1):E307–E313

    Article  PubMed  Google Scholar 

  7. Sheen D, Abdulateef S (2021) Uvulopalatopharyngoplasty. Oral Maxillofac Surg Clin 33(2):295–303

    Article  Google Scholar 

  8. Van Tassel J, Chio E, Silverman D, Nord RS, Platter D, Abidin MR (2021) Hyoid suspension with UPPP for the treatment of obstructive sleep apnea. Ear Nose Throat J 102:NP212–NP219

    Article  PubMed  Google Scholar 

  9. Chisholm E, Kotecha B (2007) Oropharyngeal surgery for obstructive sleep apnoea in CPAP failures. Eur Arch Otorhinolaryngol 264:51–55

    Article  PubMed  Google Scholar 

  10. Bosi M, De Vito A, Gobbi R, Poletti V, Vicini C (2017) The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy. Eur Arch Otorhinolaryngol 274:1251–1261

    Article  PubMed  Google Scholar 

  11. El-Anwar MW, Askar SM (2019) Hyoid periosteum sutures: a modified tissue-preserving hyoid suspension technique for obstructive sleep apnea. J Craniofac Surg 30(3):e231–e233

    Article  PubMed  Google Scholar 

  12. Lin H-Y, Lin Y-C, Hsu Y-S, Shih L-C, Nelson T, Chang W-D et al (2020) Comparison of findings between clinical examinations and drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome. Int J Environ Res Public Health 17(17):6041

    Article  PubMed  PubMed Central  Google Scholar 

  13. He M, Yin G, Zhan S, Xu J, Cao X, Li J et al (2019) Long-term efficacy of uvulopalatopharyngoplasty among adult patients with obstructive sleep apnea: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 161(3):401–411

    Article  PubMed  Google Scholar 

  14. Jaeger J (2018) Digit symbol substitution test: the case for sensitivity over specificity in neuropsychological testing. J Clin Psychopharmacol 38(5):513

    Article  PubMed  PubMed Central  Google Scholar 

  15. Choi BK, Yun IS, Kim YS, Roh TS, Park SE, Bae JY et al (2019) Effects of hat-shaped mortised genioplasty with genioglossus muscle advancement on retrogenia and snoring: assessment of aesthetic, functional, and psychosocial results. Aesthetic Plast Surg 43:412–419

    Article  PubMed  Google Scholar 

  16. Tan BKJ, Teo YH, Tan NKW, Yap DWT, Sundar R, Lee CH et al (2022) Association of obstructive sleep apnea and nocturnal hypoxemia with all-cancer incidence and mortality: a systematic review and meta-analysis. J Clin Sleep Med 18(5):1427–1440

    Article  PubMed  PubMed Central  Google Scholar 

  17. Liu SY-C, Riley RW, Yu MS (2020) Surgical algorithm for obstructive sleep apnea: an update. Clin Exp Otorhinolaryngol 13(3):215

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lin Q-C, Chen L-D, Yu Y-H, Liu K-X, Gao S-Y (2014) Obstructive sleep apnea syndrome is associated with metabolic syndrome and inflammation. Eur Arch Otorhinolaryngol 271(4):825–831

    Article  PubMed  Google Scholar 

  19. Zaghi S, Holty J-EC, Certal V, Abdullatif J, Guilleminault C, Powell NB et al (2016) Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Neck Surg 142(1):58–66

    Article  Google Scholar 

  20. Virk JS, Kumar G, Al-Okati D, Kotecha B (2014) Radiofrequency ablation in snoring surgery: local tissue effects and safety measures. Eur Arch Otorhinolaryngol 271:3313–3318

    Article  PubMed  Google Scholar 

  21. Baptista PM, Costantino A, Moffa A, Rinaldi V, Casale M (2020) Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: patient selection and new perspectives. Nat Sci Sleep 12:151–159

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kezirian EJ, Goldberg AN (2006) Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review. Arch Otolaryngol Head Neck Surg 132(2):206–213

    Article  PubMed  Google Scholar 

  23. Holty J-EC, Guilleminault C (2010) Surgical options for the treatment of obstructive sleep apnea. Med Clin 94(3):479–515

    Google Scholar 

  24. Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89(6):923–934

    Article  CAS  PubMed  Google Scholar 

  25. De Meyer MM, Jacquet W, Vanderveken OM, Marks LA (2019) Systematic review of the different aspects of primary snoring. Sleep Med Rev 45:88–94

    Article  PubMed  Google Scholar 

  26. Mediano O, Romero-Peralta S, Resano P, Cano-Pumarega I, Sánchez-de-la-Torre M, Castillo-García M et al (2019) Obstructive sleep apnea: emerging treatments targeting the genioglossus muscle. J Clin Med 8(10):1754

    Article  PubMed  PubMed Central  Google Scholar 

  27. Heiser C, Eckert D (2019) Pathophysiology of obstructive sleep apnea. HNO 67:654–662

    Article  CAS  PubMed  Google Scholar 

  28. Riley RW, Powell NB, Guilleminault C (1986) Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg. 94(6):589–593

    Article  CAS  PubMed  Google Scholar 

  29. Riley RW, Powell NB, Guilleminault C (1994) Obstructive sleep apnea and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg 111(6):717–721

    Article  CAS  PubMed  Google Scholar 

  30. Song SA, Wei JM, Buttram J, Tolisano AM, Chang ET, Liu SYC et al (2016) Hyoid surgery alone for obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 126(7):1702–1708

    Article  CAS  PubMed  Google Scholar 

  31. El-Ahl MAS, El-Anwar MW (2016) Expansion pharyngoplasty by new simple suspension sutures without tonsillectomy. Otolaryngol Head Neck Surg 155(6):1065–1068

    Article  PubMed  Google Scholar 

  32. Askar SM, Amer HS, Awad A, El-Anwar MW (2018) Hyoid bone suspension as a part of multilevel surgery for obstructive sleep apnea syndrome. Int Arch Otorhinolaryngol 22(03):266–270

    Article  PubMed  Google Scholar 

  33. Askar S, El-Anwar M, Amer H, Awad A (2017) Single triangular suture: a modified technique for hyoid suspension as a treatment for obstructive sleep apnea: our experience with 24 patients. Clin Otolaryngol 42(6):1418–1421

    Article  CAS  PubMed  Google Scholar 

  34. Tschopp K (2007) Modification of the Hörmann technique of hyoid suspension in obstructive sleep apnoea. J Laryngol Otol 121(5):491–493

    Article  CAS  PubMed  Google Scholar 

  35. Piccin O, Scaramuzzino G, Martone C, Marra F, Gobbi R, Sorrenti G (2014) Modified hyoid suspension technique in the treatment of multilevel related obstructive sleep apnea. Otolaryngol Head Neck Surg 150(2):321–324

    Article  PubMed  Google Scholar 

  36. Genta PR, Schorr F, Eckert DJ, Gebrim E, Kayamori F, Moriya HT et al (2014) Upper airway collapsibility is associated with obesity and hyoid position. Sleep 37(10):1673–1678

    Article  PubMed  PubMed Central  Google Scholar 

  37. Askar SM, Quriba AS, Hassan EM, Awad AM, Bessar AA (2017) Voice and swallowing outcomes after hyoid suspension surgery in patients with obstructive sleep apnea. Folia Phoniatr Logop 69(5–6):271–277

    Article  PubMed  Google Scholar 

  38. Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 108(2):117–125

    Article  CAS  PubMed  Google Scholar 

  39. Neruntarat C (2003) Genioglossus advancement and hyoid myotomy: short-term and long-term results. J Laryngol Otol 117(6):482–486

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all surgeons for helping in the preparation of this paper and gathering data. It is noteworthy to mention that this manuscript is not presented in any presentation before submission.

Funding

We did not give any funding and support for this study.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran

    Zahra Eslami Panah, Saeed Sohrabpour, Reihaneh Heidari & Reza Erfanian

  2. Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Alireza Sharifi & Sepideh Zoafa

  3. Tehran University of Medical Sciences, Tehran, Iran

    Afshar Etemadi-Aleagha & Mehrdad Behzadi

  4. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Alireza Teymouri

  5. Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran

    Reihaneh Heidari

  6. Tehran University of Medical Sciences, Amir Alam Hospital, Tehran, Iran

    Reza Erfanian

Authors
  1. Zahra Eslami Panah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alireza Sharifi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sepideh Zoafa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Afshar Etemadi-Aleagha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saeed Sohrabpour
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mehrdad Behzadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alireza Teymouri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Reihaneh Heidari
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Reza Erfanian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design and analysis and interpretation of data: ZEP and RE, SS, and RH; drafting of the manuscript: SZ, ASH, AEA; statistical analysis and interpretation of data MB and AT; critical revision of the manuscript for important intellectual content: RE.

Corresponding author

Correspondence to Reza Erfanian.

Ethics declarations

Conflict of interest

There is no conflict of interest for all the authors.

Ethical approval

This study was approved by the ethics committee of Tehran University of Medical Sciences (IR.TUMS.AMIRALAM.REC.1399.037), and registered at Iranian Registry of Clinical Trials (IRCT) (IRCT: IRCT20190602043791N2).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Panah, Z.E., Sharifi, A., Zoafa, S. et al. Uvulopalatopharyngoplasty with and without modified thyrohyoid suspension for obstructive sleep apnea treatment: a randomized clinical trial. Eur Arch Otorhinolaryngol 280, 4677–4685 (2023). https://doi.org/10.1007/s00405-023-08068-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-023-08068-9

Keywords

Search

Navigation