Obstructive Sleep Apnea Is More Common After Sphincter Pharyngoplasty: A Longitudinal Comparative Analysis Of 1,000 Operations For Velopharyngeal Insufficiency
Danielle H. Rochlin, MD, Clifford C. Sheckter, MD, Rohit Khosla, MD, H. Peter Lorenz, MD.
Stanford University School of Medicine, Palo Alto, CA, USA.
PURPOSE: Obstructive sleep apnea (OSA) is a troublesome complication following surgical management of velopharyngeal insufficiency (VPI). The purpose of this study is to evaluate the comparative incidence of OSA following VPI surgery on a national scale.
METHODS: A retrospective analysis of patients aged 12 years or younger who underwent VPI surgery was performed using the Truven MarketScan national databases. Patients were tracked longitudinally from 2007-2016 to evaluate the incidence of OSA. Multivariable logistic regression was used to evaluate predictors of postoperative OSA and surgical revision.
RESULTS: 1,000 patients with a mean age of 5.4±2.9 years underwent a pharyngeal flap (61.6%), sphincter pharyngoplasty (21.2%), or palatal lengthening +/- island flaps (17.2%). Underlying diagnoses were predominantly cleft lip/palate (54.8%) and congenital anomalies of the oropharynx (42.5%). 82 patients (8.2%) developed OSA at 21.3±2.6 months postoperatively. OSA was more common following sphincter pharyngoplasty (11.8%) compared to pharyngeal flap (8.3%) or palatal lengthening (3.5%, p=0.013). Predictors of OSA included older age (p=0.034), procedure type (p=0.021), and congenital anomalies of the oropharynx (p=0.041). Patients who were treated with a pharyngeal flap compared to sphincter pharyngoplasty were less likely to undergo revision (odds ratio 0.43, p=0.012). Among patients with cleft lip/palate, 39 patients developed OSA (4.8%) without a significant association between procedure and OSA diagnosis.
CONCLUSION: Sphincter pharyngoplasty is associated with a higher incidence of postoperative OSA and revision compared to palatal lengthening and/or pharyngeal flap among all patients who underwent VPI surgery. Further investigation is needed to explore associations specifically among the cleft lip/palate population.
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