A New Philosophy in Surgical Management of Snoring: Tolerability and Effectiveness of the Barbed Roman Blinds Technique

Abstract

Objectives: Evaluate the tolerability and effectiveness of the Barbed Roman Blinds Technique (BRBT), a new non-resective procedure in which the tenso-structural modifications of the fibro-muscular tissues of the soft palate and the lateral pharyngeal walls, created by means of barbed sutures (QUILL), reduce the collapsibility of the retro-palatal space. Methods: A prospective study was carried out at the Ospedale Maggiore Policlinico University of Milan, Italy, from September 2012 to June 2103. Twelve snoring patients with mild obstructive sleep apnea syndrome (OSAS; AHI <20) underwent drug-induced-sleep-endoscopy and contextual BRBT under general anesthesia. Patient satisfaction was measured with visual analog scale (VAS), snoring with linear-analog-scale (LAS) and snoring-scale-score (SSS), daytime sleepiness with Epworth Sleepiness Scale (ESS). Polysomno-graphy was repeated 6 months postoperatively. Results: Eight males and 4 females, median age 47.5 years (range, 38-61 months) had no significant postoperative morbidities or complications. The most common complaint was mild swallowing pain with spontaneous resolution within 5 to 7 days. After a median follow-up of 10 months (range, 15-8 months), a stable space-structural remodeling of the velo-uvulopharyngeal tissues was observed; improvement of snoring was confirmed by reduction in LAS and SSS; high VAS satisfaction values and reduction of ESS and AHI were recorded. Conclusions: BRBT represents an effective, nonresective, reversible, repeatable and well-tolerated procedure to relieve snoring. Considering the observed reduction of AHI and ESS, the role of BRBT in moderate-severe OSAS is currently under study.