Expansion Pharyngoplasty Research Articles

Efficacy of Expansion Pharyngoplasty without Drug-induced Sleep Endoscopy Screening in Obstructive Sleep Apnea.

Introduction Expansion sphincter pharyngoplasty has been shown to be a good alternative to continuous pressure devices in patients with moderate to severe obstructive sleep apnea. On the other hand, drug-induced sleep endoscopy provides information on the pattern of collapse in obstructive sleep apnea, although it is unclear whether this information improves the surgical outcomes. Objective To evaluate the success rate obtained when performing expansion sphincter pharyngoplasty on a group of patients diagnosed with moderate to severe obstructive sleep apnea who were not previously selected by drug-induced sleep endoscopy. Methods We present a series of patients with moderate to severe obstructive sleep apnea who underwent surgery. Pre- and postoperative home sleep apnea tests were performed. The success rate was calculated, and we assessed whether there were statistically significant pre- and postoperative differences in the apnea-hypopnea index and oximetry values. Results In total, 20 patients were included, and the surgical success rate was of 80%. Statistically significant improvements were demonstrated in the mean apnea-hypopnea index (from 40.25 ± 15.18 events/hour to 13.14 ± 13.82 events/hour; p < 0. 0001), the mean oximetric data (from 26.3 ± 12.97 desaturations/hour to 13.57 ± 15.02 desaturations/hour; p = 0.034), and in the mean percentage of total sleep time in which the patient had less than 90% of saturation (from 8.64 ± 9.25% to 4.4 ± 7.76%; p = 0.028). Conclusion The results showed significant improvements in the apnea-hypopnea index and in the oximetric data, with a surgical success rate of 80%, despite the lack of prior drug-induced sleep endoscopy screening.

Lingual Tonsillectomy as Part of a DISE-Directed Multilevel Upper Airway Surgery to Treat Complex Pediatric OSA: A Safe and Appropriate Procedure.

To study the efficiency of lingual tonsillectomy (LT) as part of multilevel surgery in children with complex obstructive sleep apnea (OSA). To evaluate the safety and the outcomes of LT. Retrospective case series. Pediatric tertiary care academic center. We included all children operated for LT to treat complex OSA, from January 2018 to June 2022. All patients underwent a protocolized drug-induced sleep endoscopy (DISE) followed by a coblation LT, associated with the treatment of all other obstructive sites. Patient demographics, medical history, surgery, and outcomes were reviewed. The efficiency of LT was analyzed exclusively in patients with a preoperative and postoperative sleep study. One hundred twenty-three patients were included. Median age was 8 years (interquartile range, IQR [3-12]). Sixty-five (53%) patients had Down syndrome, 22 (18%) had a craniofacial malformation, and 8 (7%) were obese. LT was associated with adenoidectomy (n = 78, 63%), partial tonsillectomy (n = 70, 57%), inferior turbinoplasty/turbinectomy (n = 59, 48%), epiglottoplasty (n = 92, 75%), and/or expansion pharyngoplasty (n = 2, 2%). Eighty-nine patients underwent a sleep study before and after surgery. The median apnea-hypopnea index (AHI) decreased from 18 events/h (IQR [9-36]) before surgery to 3 events/h (IQR [1-5]) after surgery (P < .001) (patients with a postoperative AHI <1.5 events/h, n = 31, 35%, and an AHI <5 events/h, n = 32, 36%). Seventeen out of 30 (57%) patients could be weaned from continuous positive airway pressure after surgery. Two patients had a postoperative hemorrhage and 2 patients required a transient postoperative reintubation. In children with complex OSA, LT as part of a DISE-directed multilevel upper airway surgery, was a very efficient and safe procedure.

Expansion sphincter pharyngoplasty in OSA: a 15year review.

A 15year review of the outcomes and success rates of the Expansion Sphincter Pharyngoplasty (ESP) in the treatment of patients with obstructive sleep apnea (OSA). A systemic review with two independent searches of MEDLINE, Google Scholar, Cochrane Library and Evidence-Based Medicine Reviews to identify publications relevant to OSA and Expansion Pharyngoplasty. All relevant studies published before 31 December 2021 were included. Sixteen studies were included in this strict systematic review with a total of 747 patients who had the ESP procedure were included. The mean age was 41.3years, mean BMI 28.2, the mean pre-op AHI was 32.3 and post-op AHI was 10.0 (p < 0.05), the mean pre-op ESS was 11.4, had reduced to post-op 5.3 (p < 0.05), and the mean pre-op snore VAS decreased from 8.7 to 2.9 (p < 0.05), with a mean follow-up time of 9.5months. The overall pooled success rate for all the 747 patients was 80.0%. There were no significant reported complications noted in these studies. After 15years of presence, the expansion sphincter pharyngoplasty has shown to be reliably effective in the management of patients with OSA.

Sleep study measures on post-operative night one following expansion pharyngoplasty for obstructive sleep apnea

PurposeTo examine the changes in measures of sleep apnea severity and hypoxemia on the first post-operative night (PON1) following expansion pharyngoplasty as a means to assess the safety of same day discharge after surgery. Materials and methodsProspective cohort study of subjects with moderate-severe obstructive sleep apnea who underwent expansion pharyngoplasty at a single academic sleep surgical practice. A WatchPAT study was performed on the night immediately following surgery (PON1) and comparisons were made to baseline sleep testing. ResultsTwenty subjects who had a mean age of 45.7 ± 10.8 years old and a mean body-mass index (BMI) of 31.4 ± 3.2 kg/m2 were enrolled. Patients had baseline severe OSA with mean apnea hypopnea index (AHI) 39.4 ± 19.5/h, O2 nadir 80.8 ± 6.1 % and time with oxygen saturation below 88 % (T88) 12.3 ± 13.2 min. Measures of sleep apnea and nocturnal hypoxemia were not significantly different on PON1. AHI was increased by >20 % in 11 (55.0 %) patients. One patient demonstrated a >10 % worsening in O2 nadir, and 8 patients (45.0 %) demonstrated a >20 % worsening in T88. BMI over 32 was associated with elevated odds of worsening in T88, and anesthesia involving ketamine was associated with lower odds of a 20 % worsening in AHI or T88. ConclusionsOn PON1 following expansion pharyngoplasty, AHI and nocturnal hypoxemia are stable overall but variable on an individual basis. The decision for admission should therefore be made on a case-by-case basis. Further research is need to elucidate definitive predictors of worsening measures on PON1.

Efficacy of expansion pharyngoplasty and hypoglossal nerve stimulation in treating sleep apnea

ObjectiveWe investigated whether a palatal conversion procedure combined with a second-stage hypoglossal nerve stimulator (HGNS) insertion can be beneficial for those patients who have a complete concentric velopharyngeal collapse and may initially not meet the criteria for use of HGNS. MethodsA retrospective chart review included all patients who underwent a planned multi-level sleep surgery including expansion sphincter pharyngoplasty (ESP) followed by HGNS. All patients had a complete concentric collapse (CCC) of the velopharynx (VP) on pre-intervention drug-induced sleep endoscopy (DISE) and were initially not a candidate for HGNS. These patients then underwent ESP followed by a DISE to confirm elimination of the CCC of the VP. They then went on to HGNS implantation several months later followed by a sleep study. ResultsA total of 20 patients were identified and included in the retrospective chart analysis. All patients who underwent ESP successfully converted their VP from CCC to an anterior-posterior collapse pattern and thus met inclusion criteria for HGNS. After the HGNS was implanted, patients showed a significant reduction of the mean AHI from 53.9 before ESP to 8.2 after ESP and HGNS and a decrease in the Epworth Sleep Score (ESS) from a mean of 13.3 to 5.7. ConclusionESP can be effective in eliminating the CCC of the VP thus making patients become HGNS candidates. In selected OSA patients, who have multilevel upper airway obstruction with complete concentric VP collapse, the combination of ESP and HGNS insertion should be considered as a planned 2-staged approach.Level of evidence: 4.

EVALUATION OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME UNDERGOING FUNCTIONAL EXPANSION PHARYNGOPLASTY, IN A HOSPITAL IN CURITIBA

Obstructive Sleep Apnea Syndrome (OSAS) has been increasingly recognized as a high prevalence condition and an independent risk factor for cardiac, metabolic, neurological, and perioperative morbidities, as well as erectile dysfunction, and traffic accidents, with non-standard surgical treatments and controversial results that do not seem to keep pace with the promising findings in the pathophysiology of the disease. The aim of this study was to evaluate the results of the Functional Expansion Pharyngoplasty technique in a group of patients with OSAS and small palatine tonsils. Preoperative and postoperative anthropometric and polysomnographic data from the medical records of 13 patients, of both sexes, in a renowned hospital in Curitiba (Brazil), were retrospectively analyzed. The 50% improvement in AHI (Apnea Hypopnea Index) and/or AHI below 20/h (Sher’s criteria) were considered surgical success. As a result, 84.6% of the patients achieved a significant AHI reduction (p=0.005), with 76.9% Sher’s success rate, and an also significant sleep time reduction, with oxyhemoglobin saturation below 90% (p=0.018). It can be concluded that the Functional Expansion Pharyngoplasty technique seems to be an effective alternative for the surgical treatment of patients with Obstructive Sleep Apnea Syndrome with small palatine tonsils.

Predictors of response to sleep apnea surgery addressing the lateral pharyngeal wall collapse

PurposeTo evaluate the predictive factors for surgical success in sleep apnea surgical techniques addressing the lateral pharyngeal wall. Materials and methodsThis is a retrospective review of consecutive cases treated by functional expansion pharyngoplasty for OSA. Collected data included patients demographics, ENT physical examination and somnographic data. Furthermore inter pterygoid distance was assessed by CT scans. To determine predictors of surgical success, physical examination, CT findings, polysomnographic and demographic data were compared between the success and failure group. ResultsFifty two patients were enrolled. The mean AHI decreased significantly from 44.3 to 17 (p = 0.001). A total of 33 patients (63.5%) met the surgical success criteria. An inter pterygoid distance longer than 34 mm was the only significant predictor of success. ConclusionsInter pterygoid distance seems to be a promising parameter associated with the surgical outcomes that should be further studied to be validated as predictor of success.

Efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of OSAHS with soft palate oropharyngeal obstruction

Objective: To explore the efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Seventy-three patients(including 60 males and 13 females) with OSAHS admitted to the department of otorhinolaryngology of our hospital in recent two years were retrospectively analyzed. All the patients had velopharyngeal obstructionevaluated by electronic endoscopic Müller test and were divided into control group (34 cases) and observation group (39 cases). The patients in the control group were performed modified uvulopalatopharyngoplasty, while those in the observation group were performed relocation and expansion pharyngoplasty by suspension sutures.The scores of ESS, AHI and LSaO2 before and after treatment were collected and compared. Results: The total effective rate of the observation group was 94.87%, which was significantly higher than 79.41% of the control group. The AHI was lower and LSaO2 value was higher (χ2=-1. 896,-1. 968,P<0.05)in the observation group. The sleeping symptoms and quality of life of the two groups were significantly improved. The ESS score of the observation group was decreased more significantly than that of the control group after treatment, and the difference was statistically significant (χ2=-1.451,P<0.05). The incidence of foreign body sensation in pharynx of the observation group (89.74%) was higher than that of the control group (55.88%), and the postoperative bleeding and postoperative recurrence rate (0.00%, 2.56%) was lower than that of the control group (8.82%, 14.70%)with statistical significance (χ2=4.738,4.249,4.119,P<0.05).The incidence of transient nasopharyngeal reflux in both groups was low and statistically insignificant (χ2=0.629,P>0.05). Conclusions: Preoperative strict screening of indications plays an important role in the selection of palatopharyngeal surgery methods and curative effect. Relocation and expansion pharyngoplasty by suspension sutures can improve the clinical efficacy of OSAHS with better safety and less recurrence.

Expansion pharyngoplasty for treatment snoring and obstructive sleep apnea

Expansion pharyngoplasty for treatment snoring and obstructive sleep apnea

Early objective adherence to hypoglossal nerve stimulation therapy.

To assess early adherence to therapy with hypoglossal nerve stimulation therapy. This is a prospective study of consecutive patients with moderate to severe obstructive sleep apnea who underwent implantation of hypoglossal nerve stimulation therapy within a single academic practice and attended a follow-up appointment after greater than 30 days of therapy use. Objective adherence data were extracted from an objective monitoring database and compared to patient characteristics. The study population was 79 participants who were 29.1% female with a mean age of 58.7 ± 12.8 years old, body mass index of 28.9 ± 3.4 kg/m2, and baseline apnea-hypopnea index of 33.8 ± 17.6 events/h. In the first 7 days after device activation, average use was 7.8 h/night, with 91.9% of nights with greater than 4 hours of therapy use and an average of 0.2 pauses in therapy per night. These figures remained stable after 30 days of use: 7.7 h/night, 91.0% of nights longer than 4 hours, and 0.3 pauses per night. Objective evidence of difficulty with acclimatization was associated with age less than 60 years (odds ratio 2.8, 95% confidence interval 1.1-7.1, P = .03) and a history of prior upper airway surgery (3.9, 1.2-11.9, P = .015). Insomnia was present in 31 patients and was not associated with objective evidence of difficulty tolerating therapy. Early adherence to hypoglossal nerve stimulation is excellent (92.4% >4 hours on >70% of nights), suggesting that the acclimatization period is straightforward in most. Younger age and a history of prior upper airway surgery appear to be associated with an increased risk of difficulty with acclimatization. Huyett P. Early objective adherence to hypoglossal nerve stimulation therapy. J Clin Sleep Med. 2022;18(2):631-636.

Improving Surgical Results in Velopharyngeal Surgery: Our Experience in the Last Decade

Background and purposeThe surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results. Materials and methodsThis is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI<10/h and mean relative AHI reduction (MRR) were compared. Results82 patients were included. AHI was significantly reduced from 43.4±24/h to 15.6±18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI<10/h criteria and 74.1% by the MRR). The differences observed were statistically significant. ConclusionsBarbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort.

Introducing a new classification for drug-induced sleep endoscopy (DISE): the PTLTbE system.

A new classification system is proposed to help the interpretation of drug-induced sleep endoscopy (DISE). The purpose is to create a classification system that improves upon existing systems designed to assess suitability of lateral wall surgery such as expansion pharyngoplasty whilst improving the reliability of the classification. A qualitative study into the difficulties trainees had with existing systems was used to identify key issues that needed to be addressed. A visual description of the palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis (PTLTbE) classification was developed. Preliminary data on the inter-rater reliability of PTLTbE were collected. Twenty junior doctors were asked to interpret 5 DISE videos using the PTLTbE classification, and the kappa and percentage agreement were calculated. The Krippendorff alpha ranged between 0.56 and 0.86 for individual DISE videos which compared favourably with the results from those who also completed the VOTE classification (range 0.31 to 0.66). The overall percentage agreement for PTLTbE was 90.1%. There are a number of advantages of the PTLTbE system over other existing DISE classifications. (1) Tonsillar obstruction is separated from lateral pharyngeal wall collapse. (2) Interobserver reliability is improved, critical to improve communication, patient outcomes and future research. (3) The learning curve to use this system is short. Most doctors did not need to refer to the classification images as an aide-memoire after a few uses of the PTLTbE system. A fuller examination of the reliability of the PTLTbE system is underway along with examination of its use in clinical settings.

Videoendoscopic evaluation of swallowing in patients undergoing expansion pharyngoplasty for obstructive sleep apnea syndrome

Videoendoscopic evaluation of swallowing in patients undergoing expansion pharyngoplasty for obstructive sleep apnea syndrome

Robotic Tongue-Base Resection Combined With Tongue-Base Suspension for Obstructive Sleep Apnea.

Our primary objective was to evaluate the feasibility, morbidity, and efficacy of transoral robotic surgery (TORS) tongue-base resection (TBR) combined with tongue-base suspension (TBS) for obstructive sleep apnea (OSA) with tongue-base collapse. Our secondary objective included evaluation of factors influencing treatment success. Single-arm, prospective, observational cohort study. Patients were eligible if they had moderate-to-severe OSA (apnea hypopnea index [AHI] > 15) or positional OSA, had a tongue-base collapse and glossoptosis identified by drug-induced sleep endoscopy (DISE), and failed continuous positive airway pressure. All patients underwent TORS-TBR combined with TBS. Additionally, concomitant epiglottoplasty, uvulopalatopharyngoplasty, or expansion pharyngoplasty were performed based on DISE findings. In total, 64 patients were enrolled in the trial. The mean age was 45.9 years, mean body mass index was 30.5 kg/m2 , and mean AHI was 41.7 events/hour. The mean robotic surgical time, total volume of tongue-base tissue removed, and the length of hospital stay were 21.4 minutes, 15.16 mL, and 6.5 days, respectively. Postoperatively, almost all polysomnographic metrics improved significantly (AHI = 41.72 vs. 18.82 events/hour, lowest oxygen saturation = 80.43% vs. 85.14%, Epworth Sleepiness Scale = 10.49 vs. 4.09). The procedure provided an overall success rate of 75%, with minor morbidity. All patients experienced varying degrees of temporary lingual edema postoperatively. Tracheotomy was not required for any patient. Although no independent predictor of treatment success was determined, patients with more severe disease tend to exhibit lower response to the treatment. TORS-TBR combined with TBS is a feasible, safe, and efficient procedure for OSA with tongue-base collapse. 4 Laryngoscope, 130:2285-2291, 2020.

Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome.

Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively ( p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

Mejorando los resultados quirúrgicos de las faringoplastias: nuestra experiencia en la última década

The surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results. This is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI<10/h and mean relative AHI reduction (MRR) were compared. 82 patients were included. AHI was significantly reduced from 43.4±24/h to 15.6±18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI<10/h criteria and 74.1% by the MRR). The differences observed were statistically significant. Barbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort.

Cautery-assisted palatal stiffening operation for obstructive sleep apnea: A systematic review and meta-analysis.

ObjectiveTo systematically review outcomes for cautery-assisted palatal stiffening operation (CAPSO) as a treatment for adult obstructive sleep apnea (OSA).MethodsFive databases (including PubMed/MEDLINE) were searched through July 12, 2017.ResultsEight studies (307 patients) met criteria. Overall, CAPSO alone (80 patients) improved AHI from a mean ± standard deviation (M ± SD) of (16.8 ± 11.9) to (9.9 ± 10.9) events/h (41.1% decrease). Mixed CAPSO with/without tonsillectomy (92 patients) improved AHI from a M ± SD of (24.8 ± 12.6) to (10.6 ± 9.5) events/h (61.7% decrease). CAPSO with expansion pharyngoplasty (EP), (78 patients) improved AHI from a M ± SD of (26.3 ± 17.7) to (12.6 ± 5.8) events/h (52.1% decrease). CAPSO alone (90 patients) improved lowest oxygen saturation (LSAT) by 5.4 points. Mixed CAPSO with/without tonsillectomy (77 patients) improved LSAT by 10.6 points, and CAPSO with EP (78 patients) improved LSAT by 5.2 points. Sleepiness improved (182 patients) from an Epworth Sleepiness Scale score of 11.8 to 5.1, P < 0.001. Snoring reduced (120 patients) from 7.9 to 2.5 on visual analog scales (0–10 scale), P < 0.001.ConclusionsApnea-hypopnea index has improved by 41.0% for CAPSO alone, 61.7% for CAPSO with tonsillectomy and 52.1% for CAPSO with expansion pharyngoplasty. Additionally, lowest oxygen saturation, sleepiness and snoring have also improved after CAPSO.

Single versus double suspension sutures for selected cases of obstructive sleep apnea

ObjectiveTo compare the results of expansion pharyngoplasty using bilateral single palatal suspension sutures (SSS) versus double suspension sutures (DSS) for the treatment of selected cases of obstructive sleep apnea (OSA) with retropalatal collapse. MethodsPatients were randomly categorized into two groups: the first group for whom bilateral SSS were performed and a second group for whom bilateral DSS were done. Snoring on the basis of the visual analog scale (VAS), Epworth Sleepiness Scale (ESS), apnea hypopnea index (AHI), lowest O2 saturation were assessed preoperatively and 6 months postoperatively in all patients. ResultsDSS provided significantly more retroplatal space (p = 0.0137) and less snoring score (p = 0.0005). While no significance difference between SSS and DSS as regard inter pillar distance (p = 0.0985), AHI (p = 0.1677), ESS (p = 0.4094), and lowest O2 saturation (p = 0.0839). ConclusionBoth SSS and DSS are simple, rapid, bloodless and effective procedures for treating OSA (in patients with retropalatal collapse) with no temporary or persistent postoperative complications. Adding the second suture in DSS could significantly enlarge more retropalatal space and reduce more snoring scale than SSS.

Predictors of Obtaining Polysomnography Among Otolaryngologists Prior to Adenotonsillectomy for Childhood Sleep-Disordered Breathing.

(1) To assess the predictors for obtaining polysomnography (PSG) in children undergoing adenotonsillectomy (AT) for sleep-disordered breathing, and (2) to estimate the adherence to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline recommendations for pre-AT PSG. This was a retrospective cohort study of children who were seen in the Pediatric Otolaryngology Clinic and underwent AT for sleep-disordered breathing over a 13-month period at a single tertiary care children's hospital. Patients with and without pre-AT PSG were compared using bivariate and logistic regression analysis to identify predictors for PSG. Electronic medical records were reviewed for demographic variables, medical comorbidities, and PSG data. Adherence to AAO-HNS guideline recommendations was estimated by calculating the proportion of patients who had a PSG among those who met the recommended criteria for pre-AT PSG. Mean age was 6.6 ± 3.6 years with 53% male. A total of 65 of 324 children (20%) underwent PSG prior to AT. The only factor significantly associated with pre-AT PSG was age 1 to 3 years (odds ratio 4.5, 95% confidence interval [2.2, 9.0], P < .001). Among patients who met AAO-HNS criteria for pre-AT PSG, 28 of 128 (20%) underwent PSG compared to 35 of 186 (19%) who did not meet criteria (odds ratio 1.0, 95% confidence interval [0.6, 1.9], P = .87). Among children who underwent AT, the only significant predictor of obtaining pre-AT PSG was age 1 to 3 years. The rate of adherence to the AAO-HNS guideline recommendations was low (20%), which represents an educational opportunity.

Functional expansion pharyngoplasty: Technical update by unidirectional barbed sutures.

Functional expansion pharyngoplasty: Technical update by unidirectional barbed sutures.