Modified expansion sphincter pharyngoplasty for treatment of children with obstructive sleep apnea

JAMA Otolaryngol Head Neck Surg. 2014 Sep;140(9):817-22. doi: 10.1001/jamaoto.2014.1329.


Importance: Lateral pharyngeal wall collapse has been implicated in the pathogenesis of obstructive sleep apnea (OSA). Modified expansion sphincter pharyngoplasty (ESP) is a simple procedure and can be considered in the surgical management of children with severe OSA.

Objective: To describe a modified ESP addressing lateral pharyngeal muscle wall collapse in the treatment of children with OSA.

Design, setting, and participants: Retrospective review of the medical records of children with OSA and lateral pharyngeal muscle wall collapse who underwent modified ESP and children who had tonsillectomy and adenoidectomy (TA) for OSA between 2008 and 2013 at a tertiary care children's hospital.

Interventions: Modified ESP.

Main outcomes and measures: The primary outcome measure was the rate of cure, which was defined as an apnea-hypopnea index (AHI) lower than 1. Other outcomes were differences in preoperative and postoperative AHI, minimum saturation of peripheral oxygen, and percentage of total sleep study time with oxygen saturation less than 90%.

Results: Twenty-five children who had modified ESP and 25 AHI-matched children who had TA for severe OSA were identified. The postoperative AHI was lower than the preoperative AHI in both groups. Preoperative AHI was similar between modified ESP and TA groups. The mean (SD) postoperative AHI of the modified ESP group (2.4 [3.9]) was lower than that of the TA group (6.2 [6.0]) (P < .001). Cure rates for the modified ESP group (AHI <1, 64%; AHI <2, 72%; and AHI <5, 80%) were greater than those for the TA group (AHI <1, 8%; AHI <2, 44%; and AHI <5, 60%).

Conclusions and relevance: Modified ESP provided objective clinical improvement of OSA in children with severe OSA and lateral pharyngeal wall collapse and might serve as an effective alternative to TA for treatment of OSA.

MeSH terms

  • Adenoidectomy
  • Adenoids / pathology
  • Adenoids / surgery
  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Hypertrophy
  • Male
  • Matched-Pair Analysis
  • Otorhinolaryngologic Surgical Procedures / methods*
  • Oximetry
  • Palate, Soft / surgery
  • Palatine Tonsil / pathology
  • Palatine Tonsil / surgery
  • Pharyngeal Muscles / surgery*
  • Polysomnography
  • Retrospective Studies
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / surgery*
  • Tonsillectomy