Surgical results of different palate techniques to treat oropharyngeal collapse

Trends in Soft Palate Surgery and Reimbursements for Obstructive Sleep Apnea Among the Medicare Population

OBJECTIVES

This study aims to analyze trends in utilization and reimbursement of soft palate surgery for OSA using the Medicare national database.

METHODS

A retrospective analysis of the 2000 to 2021 Part B National Summery datafiles using current Procedural Terminology (CPT) codes 42145 (uvulopalatopharyngoplasty [UPPP]), 42950 (pharyngoplasty [PP]), and 42140 (uvulectomy [UVU]) was performed.

RESULTS

Between 2000 and 2021, the number of OSA surgeries fell 65.7% from 4208 to 1443. UPPP fell 87.6% from 3455 in 2000 to 428 in 2021 (P < .001). UVU also fell in popularity, from 568 to 376 (33.8%; P < .001). In contrast, the performance of PP rose 245.4% over time, from 185 to 639 (P < .001). When comparing 2000 to 2009, both PP and UVU rose in relative use (from 4.4% to 12.3% and from 13.5% to 20.4% of all soft palate OSA surgeries, respectively), while UPPP fell (82.1% to 67.3%; P < .001). Total Medicare payments for all 3 procedures fell 57.2% from $1 658 844 to $633 091 (P < .001). Adjusted total UPPP payments fell 88.7% (P < .001). Adjusted total PP payment rose 137.5% to $262 538 in 2021 (P < .001).

CONCLUSION

Soft palate surgery for OSA has declined amongst the Medicare population over 21 years (2000-2021). The more individualized and tissue sparing PP has risen in popularity but did not overcome the large decline of the traditional UPPP. Accordingly, there was a 75.7% fall in inflation-adjusted reimbursements. Overall, our data indicates a decline in soft palate surgery in the management of geriatric OSA, with modest relative increase in pharyngoplasty procedures.

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.

Predictors of Success of Pharyngeal Surgery in the Treatment of Obstructive Sleep Apnea: A Narrative Review

(1) Background: This narrative review aims to explore the predictors of success for pharyngeal surgery in the treatment of obstructive sleep apnea (OSA). An extensive literature search was conducted, identifying relevant studies published up to June 2023, utilizing various databases and key search terms related to OSA, surgical interventions, and predictors of success. The review encompasses both retrospective and prospective studies, case series, and cohort studies to provide a broad understanding of the topic; (2) Methods: Review of English scientific literature on phenotypes of OSA related to predictors of success of pharyngeal surgery; (3) Results: Of 75 articles, 21 were included, in these the following were determined to be factors for surgical success: body mass index (BMI) (8 articles), apnea/hypopnea index (AHI) (8 articles), cephalometry (8 articles), palatine tonsil size (7 articles), Modified Mallampati score (2 articles), genioglossus electromyography (2 articles), Friedman score or upper airway anatomy (3 articles), nasopharyngolaryngoscopy (2 articles), drug-induced sleep endoscopy (DISE) (1 article), oral cavity anatomy (1 article) and oxygen desaturation index (ODI) (1 article); (4) Conclusions: The lack of standardized protocols for the indication of pharyngeal surgery is a reality, however identifying known predictors of surgical success may facilitate homogenizing indications.

International Consensus Statement on Obstructive Sleep Apnea

BACKGROUND

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

METHODS

Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.

RESULTS

The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.

CONCLUSION

This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Expansion sphincter pharyngoplasty in OSA: a 15 year review

OBJECTIVE

A 15 year review of the outcomes and success rates of the Expansion Sphincter Pharyngoplasty (ESP) in the treatment of patients with obstructive sleep apnea (OSA).

METHODS

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.

RESULTS

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 41.3 years, 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 9.5 months. The overall pooled success rate for all the 747 patients was 80.0%. There were no significant reported complications noted in these studies.

CONCLUSION

After 15 years of presence, the expansion sphincter pharyngoplasty has shown to be reliably effective in the management of patients with OSA.

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

PURPOSE

To evaluate the predictive factors for surgical success in sleep apnea surgical techniques addressing the lateral pharyngeal wall.

MATERIALS AND METHODS

This 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.

RESULTS

Fifty 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.

CONCLUSIONS

Inter 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.

Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis

OBJECTIVES

To compare the efficacy and success rates of lateral pharyngoplasty techniques (LP) vs. uvulopalatopharyngoplasty (UPPP) among adult patients surgically treated for obstructive sleep apnea.

METHODS

A systematic literature review of the last 20 years' papers was conducted using PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library until April 2021. Only full-text English articles comparing LP and UPPP outcomes in adult patients with objective outcomes were included in the study.

RESULTS

We included 9 articles for a total of 312 surgically treated patients with OSA. LP techniques for obstructive sleep apnea were used on 186 (60%) subjects, while 126 patients (40%) were treated with UPPP. Both surgical procedures resulted in significant improvements in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and lowest oxygen saturation (LOS) (p < 0.001 in all cases). Although better outcomes were reported with lateral pharyngoplasty, the differences were not significant compared to UPPP post-operative results (p > 0.05 in all cases).

CONCLUSIONS

UPPP and LP are both effective surgical procedures in treating OSA in adults. Although not significant, LPs demonstrated improved post-operative outcomes. However, further evidence comparing the surgical effect on patients with OSA is needed to discriminate post-operative outcomes.

Barbed Reposition Pharyngoplasty versus Expansion Sphincter Pharyngoplasty: A Meta-Analysis

OBJECTIVE

This study was to compare barbed reposition pharyngoplasty (BRP) and expansion sphincter pharyngoplasty (ESP) in the treatment of obstructive sleep apnea (OSA).

METHODS

Relevant 907 articles were searched from various databases until August 2020, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science and Scopus, and reference lists.

RESULTS

Four studies with a total of 208 participants were included. The mean reduction of apnea-hypopnea index (AHI) in the BRP group was 74.03% and the mean reduction of AHI in the ESP group was 60.17%. The mean success rate in the BRP group and the ESP group was 84.96% and 79.87%, respectively. The mean difference (MD) of the change in AHI between groups was not significantly different (MD = -1.24 event/hr, 95% CI [-11.86, 9.36], P = .82). There was no significant difference in postoperative AHI, postoperative Epworth Sleepiness Scale, pain, hospital stay, time to oral diet, and the change in oxygen desaturation index in both groups whereas the analgesic requirement was lower in the BRP group. Operative time was lower in the BRP group (MD = 21.72 minutes, 95% CI [18.85, 24.60], P < .0001).

CONCLUSION

The outcomes in both procedures are comparable in the improvement of OSA with palatal collapse. BRP is superior to ESP in term of surgical time. However, randomized clinical controlled trials with multicenter cooperation and long-term follow-up are essential to further demonstrate the efficacy of these procedures. Laryngoscope, 131:1420-1428, 2021.

Palatopharyngoplasty and Palatal Anatomy and Phenotypes for Treatment of Sleep Apnea in the Twenty-first Century

Successful palatopharyngoplasty is critical for successful sleep apnea surgery. Traditional uvulopalatopharyngoplasty was primarily excisional, whereas newer techniques, such as expansion sphincterpharyngoplasty, are more reconstructive. Studies of flow dynamics even demonstrate that the effectiveness of maxillofacial surgery is significantly mediated through stiffening and enlargement of the lateral retropalatal and pharyngeal airway. The current modified technique of uvulopalatopharyngoplasty/expansion sphincteroplasty aims to maximize relocation and tension on the palatopharyngeus muscle, opening the retropalatal airway and the palatal genu, and minimizing tension on the final mucosal closure.

Prospective multi-center study on expansion sphincter pharyngoplasty

BACKGROUND AND OBJECTIVE

The aim of this study was to demonstrate the long-term effectiveness of Expansion Sphincter Pharyngoplasty (ESP) as a standalone surgical treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) patients through a prospective multi-center study.

MATERIAL AND METHODS

A prospective non-comparative multicenter study of patients suffering from OSHAS selected after drug-induced sleep endoscopy, with ESP as standing alone procedure was performed. Inclusion criteria were lateral collapse on oropharynx and preoperative AHI between 5 and 70. Minimum follow-up was >12 months. Outcome measures were Epworth sleepiness scale (ESS), AHI, success rate and CPAP need after surgery.

RESULTS

A total of 75 ESP were performed. Mean patient age was 46.7 ± 10.5 years. Mean pre-operative and post-operative AHI was 22.1 ± 12.2 and 8.6 ± 6.7, respectively (p < .001). Mean pre-operative and post-operative ESS score was 11.5 ± 4.7 and 4.6 ± 6.6, respectively (p < .001). AHI <5 was obtained in 25 patients (33.3%), and CPAP was not further needed after surgery in a total of 62 patients (82.6%).

CONCLUSIONS AND SIGNIFICANCE

In this prospective multi-center study, patients undergoing ESP standing alone for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.

Efficiency of Expansion Sphincter Pharyngoplasty in the Treatment of Obstructive Sleep Apnea Syndrome

Objective

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of upper respiratory-tract obstruction during sleep and decrease in arterial oxygen saturation. Expansion sphincter pharyngoplasty (ESP) is a simple, safe, and effective method for the surgical treatment of OSAS. The aim of our study was to evaluate the efficacy of ESP with polysomnography (PSG) in OSAS patients.

Methods

This study was conducted on patients referred to our center for the treatment of snoring, apnea, witnessed apnea, and daytime sleepiness during 2010-2018. Overall, 67 patients (16 females, 51 males) who had PSG test at postoperative three months and were considered suitable with history, physical examination, and surgery after PSG were included in the study. Patients were classified into three groups according to OSAS severity: mild, moderate, and severe. Patient age, sex, body mass index (BMI), pre- and postoperative period apnea-hypopnea index (AHI), Epworth sleepiness scores, and PSG data were recorded.

Results

The mean BMI of all groups was 27.44±2.73. The postoperative AHI decreased from 18.26±2.23 to 8.01±0.97 (p<0.001). Surgical success rate was 67.2%; it was higher in females (p=0.047). The highest success rate was found in the mild OSAS group; however, this difference was not statistically significant when compared to the other groups (p=0.217). There were statistically significant improvement at postoperative Epworth sleepiness scores and minimum O₂ saturations (p<0.001 and p=0.018, respectively).

Conclusion

ESP is an effective and successful surgery in selected patients with lateral pharyngeal and retropalatal narrowing.

Expansion sphincter pharyngoplasty: Usefulness of DISE

OBJECTIVES

The aim of this study was first to present the indications and results using expansion sphincter pharyngoplasty to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS). And second, to compare the findings of drug-induced sleep endoscopy (DISE) before and after the surgery.

MATERIAL AND METHODS

The study design was a prospective cohort of patients surgically treated between 2015 and 2016. All patients were diagnosed with mild to severe obstructive sleep apnoea and did not tolerate CPAP. All had pre- and post-surgery DISE and polysomnography. The inclusion criteria were age, between 18 years and 70 years, small tonsils (sizes 1 and 2), Friedman II and III clinical stage, and lateral collapse in preoperative DISE. We performed surgery to the palate only, using expansion sphincter pharyngoplasty.

RESULTS

Seventeen patients were included, 52.94% had severe OSAHS. Average age was 42 years, average body mass index was 28. The surgical success rate according to Sher criteria was 82.35%. 41.17% had a postoperative apnoea-hypopnoea index of less than 10. Seventy-five percent of the patients had no further need for CPAP.

CONCLUSION

Expansion sphincter pharyngoplasty is a safe technique for treating OSAHS, in patients with small tonsils, Friedman grade I and II and collapse of lateral walls in DISE, in the absence of multilevel collapse. The postoperative DISE showed improvement of the lateral collapse was achieved with the expansion.

Palate surgery for obstructive sleep apnea: a 17-year meta-analysis

OBJECTIVES

Systematic review of palate surgery for the treatment of OSA.

METHODS

Independent searches to identify publications relevant to OSA treatment and upper airway palate surgery. All relevant studies published between January 2001 and February 2018 were included. Inclusion criteria were adult patients, documented airway evaluation methods and absent hypopharyngeal collapse. Outcomes included success rates of treatment, AHI, Epworth scale, QOL and snoring VAS.

RESULTS

Fifty-nine papers with a total of 2715 patients, UPPP accounted for 16.7% of all the procedures. Evident differentiation progressing from 2001 to 2018, from 2001 to 2010, the percentage of UPPP procedures were 25.67%, from 2011 to 2018, there were only 12.6% of UPPP procedures. The average follow up was 8.18 months. Meta-analysis on the AHI change for all procedures, showed the fixed effect AHI per follow-up (FU) month change was 1.45 (95% CI 1.33, 1.8), p < 0.001; while for ESS, the fixed effect AHI per FU month change was 0.61 (95% CI 0.56, 0.66), p < 0.001. The mean decrease in AHI was from 35.66 to 13.91 (p < 0.001). The mean decrease in ESS was from 11.65 to 5.08 (p < 0.001). The mean AHI change was 19.9 (p < 0.001). The mean ESS change was 5.8 (p < 0.001). The overall pooled success rate was 67.5%. Meta-analysis of the procedures, showed that the respective mean AHI reduction was 24.7 for the anterior palatoplasty (p = 0.015), 19.8 for the lateral/expansion pharyngoplasty (p = 0.046), and 17.2 for the uvulopalatopharyngoplasty (p = 0.360).

CONCLUSIONS

Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea

The surgical treatment of obstructive sleep apnoea in patients who are non-compliant with continuous positive airway pressure therapy still represents a valid alternative. In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery. Barbed reposition pharyngoplasty in multilevel robotic surgery for OSA may represent a valid option to surgically approach the soft palate. Herein, we describe the technique and preliminary results of our experience.

Fibronasolaringoscopia en el diagnóstico de síndrome de apnea-hipopnea obstructiva del sueño (SAHOS)

En los pacientes con diagnóstico de trastornos respiratorios del sueño (TRS) no se ha podido asociar ningún hallazgo anatómico a la severidad de la patología que el paciente presenta o a su éxito quirúrgico. Los avances actuales en la tecnología de video han permitido evaluar de manera más fidedigna las medidas de la vía aérea (VA) y trazar un mapa más exacto del sitio específico de obstrucción. La fibronasolaringoscopia es una técnica accesible y económica para la evaluación de la VA en múltiples posiciones en períodos de sueño y vigilia; esta requiere un amplio conocimiento por parte del examinador de la anatomía y fisiología de la vía aérea superior para determinar los sitios exactos de obstrucción y los patrones de colapso que podrían determinar la posibilidad del manejo quirúrgico o no, haciendo de este examen diagnóstico parte fundamental en el estudio de los pacientes con TRS.

A tertiary center experience with velopharyngeal surgical techniques for treatment of snoring and obstructive sleep apnea

OBJECTIVES

The aim of this study was to assess the outcomes of patients who treated with the relatively new surgical procedures; anterior palatoplasty (AP), Cahali lateral pharyngoplasty (CLP), and expansion sphincter pharyngoplasty (ESP) for habitual snoring or obstructive sleep apnea (OSA).

METHODS

Prospective series of 93 patients were evaluated. The performed surgical techniques, polysomnographic outcomes, pre- and postoperative clinical parameters, and complication rates were assessed.

RESULTS

There were 14 snorers and 79 OSA patients. The mean age was 40.7 years, mean BMI was 27.67kg/m², and the mean follow-up time was 5.90 months. There were 30 subjects in AP, 30 subjects in CLP, and 33 subjects in ESP groups. Apnea hypopnea index (AHI) improved from 16.90 to 14.27 (p=0.135) in AP, from 17.69 to 12.05 in CLP (p=0.004), and from 26.83 to 9.08 in ESP groups (p<0.001). When surgical success criteria is defined as more than 50% reduction in AHI to final AHI <15events/h, success rates were 45%, 64%, and 74% in AP, CLP, and ESP groups, respectively. Epworth Sleepiness Scale and visual analog scale for snoring significantly decreased after all procedures (p<0.05). The minimum oxygen saturation significantly increased after all procedures, however, only ESP caused statistically significant improvements in oxygen desaturation index, mean SaO₂ and the percentage of sleep time with SaO₂ below 90%. During the follow-up period, 61 of 93 patients (65.6%) indicated one or more complaints, but none of them was persistent.

CONCLUSION

We suggest that these relatively new velopharyngeal surgical techniques are effective in the management of snoring and OSA without causing persistent side-effects, and ESP is one step ahead of the other two techniques.

Combined Expansion Pharyngoplasty and Anterior Palatoplasty for the Treatment of OSA

To evaluate the success rates of combined Expansion Sphincter Pharyngoplasty and the Anterior Palatoplasty in the treatment of OSA. A two center prospective series of 73 patients with OSA. All patients were >18 years old, retro-palatal obstruction, concentric velo-pharyngeal collapse, BMI < 33, Friedman clinical stage II, with all grades of AHI. The procedure involved the anterior palatoplasty, tonsillectomy and expansion sphincter pharyngoplasty with or without nasal surgery. There were 68 men and 5 women, the mean age was 46.8 years old (range of 25-67 years), mean BMI was 25.5 (range of 20.3-31.2). All patients had pre-operative and post-operative PSG. The AHI improved in all patients, mean AHI improved from 26.3 ± 17.7 to 12.6 ± 5.8 (p < 0.001). There were 20 mild OSA, 33 moderate OSA and 20 severe OSA patients. Twenty-three patients had pre-operative DISE, and 61 patients had nose/palate surgery, while only 12 had palate surgery alone. The overall success rate (50 % reduction and AHI < 20) was 86.3 %. The mean snore scores (VAS) improved from 8.8 ± 1.2 to 2.0 ± 1.3 (p < 0.001). The mean Epworth score improved from 11.5 ± 2.2 to 2.9 ± 2.1 (p < 0.001). Lowest oxygen saturation also improved in all patients. Subjectively, all the patients felt less tiredness. Pre-operative DISE assessment did not seem to confer any advantage over the patients who had no pre-operative DISE (p = 0.027), and patients who had nose/palate surgery seemed to have better success rates compared to those who only had palate surgery (p = 0.081). This combined technique has been shown to be effective in selected group of OSA patients. Level of evidence IV.

Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40-300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05-1.49) and body mass index (OR, 1.48, 95% CI 1.02-2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301-850 Hz; OR, 0.84, 95% CI 0.74-0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301-850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses.

Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis

This study seeks to determine the success rates of the expansion sphincter pharyngoplasty and its variants on the treatment of obstructive sleep apnea (OSA). Systematic review and meta-analysis. 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 March 2015 were included. Five studies were included in the systematic review and meta-analysis. The numbers of patients in each paper ranged from 10 to 85 (total = 155), and mean age ranged from 8 to 56 years. Substantial and consistent improvement in PSG outcomes were observed post-expansion pharyngoplasty patients, with or without multilevel surgery groups. The results showed that the expansion pharyngoplasty technique has significantly lower AHI than control group [Standardised mean difference -7.32, 95 %CI (-11.11, -3.52), p = 0.0002]; however, substantial heterogeneity between these studies were observed. The mean pre-operative AHI (in the five papers) improved from 40.0 ± 12.6 to 8.3 ± 5.2 post-operatively. The overall pro-rated pooled success rate for all the patients was 86.3 %. The expansion pharyngoplasty is effective in the management of patients with OSA.