Combined Elliptical Window Genioglossus Advancement, Hyoid Bone Suspension, and Uvulopalatopharyngoplasty Decrease Apnea Hypopnea Index and Subjective Daytime Sleepiness in Obstructive Sleep Apnea

Purpose: The objective and subjective outcomes of combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures have not been evaluated. This study was conducted to evaluate postoperative changes in the apnea hypopnea index (AHI) and subjective daytime sleepiness with this combination of procedures in the surgical management of obstructive sleep apnea (OSA).

Patients And Methods: This was a retrospective cohort analysis of patients who had undergone combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty performed at Allegheny General Hospital (Pittsburgh, PA) from July 1, 2006 through December 31, 2008 for polysomnogram-confirmed OSA. Inclusion criteria included patients who had undergone the combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures with preoperative and minimum 6-month postoperative AHI and Epworth Sleepiness Scale (ESS). Statistical significance between mean differences of pre- and postoperative AHI and ESS was determined with the 2-tailed paired t test and 95% confidence intervals.

Results: Thirteen male patients (average age, 43.0 ± 2.4 yr; average follow-up, 18.0 ± 3.6 months) were included in this study. There were statistically significant differences between mean pre- and postoperative AHI (28.3 vs 12.1; P < .05; mean change, -16.2; 57.2% decrease) and ESS (15.2 vs 6.3; P < .05; mean change, -8.9; 58.6% decrease).

Conclusion: The combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures for the treatment of OSA decrease AHI and subjective daytime sleepiness.