The effectiveness of combined tonsillectomy and anterior palatoplasty in the treatment of snoring and obstructive sleep apnoea (OSA)

Abstract

The prevalence of obstructive sleep apnoea (OSA) is increasing due to a rising rate of obesity. Multiple surgical techniques used to address obstruction at the palatal level have been associated with significant morbidities. Few studies have reported good outcomes of anterior palatoplasty (AP) in mild-to-moderate OSA. The aim of this study is to investigate the effectiveness of combining tonsillectomy and anterior palatoplasty in the treatment of snoring and OSA. All patients with snoring and OSA treated with tonsillectomy and anterior palatoplasty were analyzed. The primary outcome was reduction of the apnoea hypopnoea index (AHI) with surgical success criteria; reduction of AHI by ≥50% and AHI ≤10. The secondary outcomes measured were patients' Epworth Sleepiness Scale (ESS) and snoring visual analogue scale (VAS) scores. Thirty one patients completed the study, where 19% had mild, 42% moderate, and 39% had severe OSA. The mean surgical success rate was 45% at 3 months and 32% at 1-year post-operatively. There was a significant reduction of ESS and VAS at 3 months and 1-year post-operatively (p < 0.05). Combination of tonsillectomy and anterior palatoplasty could be considered as a treatment option for snoring and OSA in selected groups of patients (mild-to-moderate OSA with mainly retropalatal obstruction). The surgical success was found to reduce with time, and BMI optimization should be emphasized as part of post-operative care.

Keywords: Anterior; Apnoea; Obstructive; Palatoplasty; Sleep; Snoring; Tonsillectomy.