Introduction
Obstructive sleep apnea (OSA), caused by airway collapse during sleep, is associated with chronic conditions like cardiovascular disease1. First-line treatments include lifestyle changes and positive airway pressure (PAP) devices, but adherence is often low, with up to 83% of patients non-adherent2,3. Despite advancements in the surgical treatment of OSA over the past decade, particularly with hypoglossal nerve stimulators, hyoid suspension may still be beneficial for select patients, especially those who who wish to avoid an implantable device or have exhausted other surgical options. Few studies have examined OSA-related outcomes for hyoid suspension and predictors of success.
Methods
This is a retrospective case series of adult patients with OSA who underwent hyoid suspension at a single tertiary center. Patients were excluded if they did not have pre- and post-operative sleep study data. Change in AHI and ESS scores from pre-op to post-op were estimated using paired t tests. Data were analyzed using stratified analyses, simple linear regression models, and univariate logistic regression models .
Results
There were 43 patients who underwent hyoid suspension from 2012 to 2023 with a mean (SD) age of 47.7 (9.5) years, mean (SD) BMI of 31.4 (6.9) kg/m2, and mean pre-operative AHI of 30.6 (21.1) events/hr. Most patients had an adjuvant procedure performed at the same time including palatal surgery (n=35), nasal surgery (n=16), and/or genioglossus advancement (n=27). There was a statistically significant improvement in the pre- and post-surgery AHI, with a mean difference of -9.4 (95% CI –17.1 to –1.6, p=0.019). The ESS also improved significantly, with a mean difference of -2.0 (95% CI –3.7 to –0.3, p=0.025). In a linear regression model, higher pre operative AHI was correlated with greater reduction in AHI (beta-coefficient -0.60, p<0.001) and adjuvant genioglossus advancement was correlated with an increase in AHI (beta-coefficient 21.6, p=0.005). Thirteen (30.2%) of patients achieved success based on Sher20 criteria.
Conclusions
Hyoid suspension results in a modest but significant improvement in AHI and ESS. Hyoid suspension may still play an important role for the treatment of OSA, but additional research is needed to optimize patient selection..
References
Dempsey, J. A., Veasey, S. C., Morgan, B. J., & O’Donnell, C. P. (2010). Pathophysiology of Sleep Apnea. Physiological Reviews, 90(1), 47–112. https://doi.org/10.1152/physrev.00043.2008
2. Dixon, J. B., Schachter, L. M., O’Brien, P. E., Jones, K., Grima, M., Lambert, G., Brown, W., Bailey, M., & Naughton, M. T. (2012). Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea: A Randomized Controlled Trial. JAMA, 308(11), 1142–1149. https://doi.org/10.1001/2012.jama.11580
3. Weaver, T. E., & Grunstein, R. R. (2008). Adherence to Continuous Positive Airway Pressure Therapy. Proceedings of the American Thoracic Society, 5(2), 173–178. https://doi.org/10.1513/pats.200708-119MG