Effectiveness of Drug Induced Sleep Endoscopy in improving outcomes of Barbed Pharyngoplasty for Obstructive Sleep Apnea Surgery: a prospective randomized trial

Purpose: To observe the effectiveness of preoperative drug induced sleep endoscopy in improving surgical results of patients submitted to single level barbed pharyngoplasty surgery for OSA, using a prospective randomized model. Methods: A single center randomized, controlled trial with two prospective arms was carried out to compare functional results in patients treated with Barbed Reposition Pharyngoplasty (BRP) surgery without a preoperative drug induced sleep endoscopy (DISE) evaluation vs patients treated with BRP surgery performed after DISE evaluation of sites/patterns of collapse. Results: We compared 50 patients who underwent BRP without a preoperative DISE evaluation (Group A) and 42 patients (Group B) treated with BRP surgery but preoperatively selected by means of a preoperative DISE. In this second group of patients, after DISE evaluation, 70% of patients were selected for single level BRP surgery because they showed an isolated velopharyngeal collapse at the DISE evaluation, without obstruction at other upper airway levels evaluated. Both groups of patients showed a statistically significant difference between preoperative and postoperative values of AHI, ODI and LOS (p<0.05 in all cases). Comparing Group A and Group B patients, the therapeutic success rate was found to be 60% in patients treated without preoperative DISE evaluation and 83% in patients treated with preoperative DISE (p = 0.02). Conclusion: DISE would seem to improve the surgical results of single-level velo-pharyngeal surgery due to the possibility of excluding patients with obstruction of the base of the tongue, hypopharynx and the epiglottis / larynx.