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Video

Sleep Medicine

(A1205) Assessing the Impact of Hyoid Suspension in Multilevel Sleep Surgery: A Systematic Review and Meta-analysis

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Sean Graham, BS

    3rd Year Medical Student
    University of Tennessee Health Science Center
    Memphis, Tennessee, United States

    • Co-Author(s)

  • Emily R. Baker, MD

    Resident Physician
    Vanderbilt University Medical Center
    Memphis, Tennessee, United States

  • JJ

    Joel James, MD

    Resident Physician
    University of Tennessee Health Science Center
    Memphis, TN, United States

    • Senior Author(s)

  • MG

    Marion B. Gillespie, MD, MSc

    Professor and Chair
    UTHSC
    Memphis, Tennessee, United States

Disclosure(s):
Sean Graham, BS: No relevant relationships to disclose.
Emily R. Baker, MD: No relevant relationships to disclose.
Joel James, MD: No relevant relationships to disclose.
Marion B. Gillespie, MD, MSc: No relevant relationships to disclose.


Introduction: Multilevel sleep surgery (MLS) is a well-established approach to the surgical treatment of obstructive sleep apnea (OSA). While uvulopalatopharyngoplasty (UPPP) is the widely favored method to treat obstruction at the level of the soft palate, there is not a clear consensus among sleep surgeons for the best treatment approach for hypopharyngeal obstruction. This study aims to compile current literature to understand the impacts of hyoid suspension (HS) on polysomnographic variables.

Methods: This study was conducted in accordance with PRISMA guidelines. 4 databases (PubMed, Cochrane, Scopus, Embase) were searched through December 2024. Study screening, risk of bias analysis, and data extraction were performed independently by two reviewers. All conflicts were resolved by a third reviewer. Outcome variables included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and lowest oxygen saturation (LSAT).

Results: Database searches yielded 1102 studies; 100 articles were screened and 26 met inclusion criteria. Pooled data included 919 patients who received HS in combination with palatal level surgery as part of a multilevel approach and 48 who underwent isolated HS alone. The average AHI of the MLS group decreased from 40.5 preoperatively to 18.2 postoperatively, for a statistically significant average AHI reduction of 55% (MD 22.3, 95% CI 18.0-27.3). This group also saw significant improvements in ESS scores (MD 4.6, 95% CI 3.4-5.9) and LSAT (MD 8.6, 95% CI 3.9-13.3). The average AHI reduction in the isolated HS group was less pronounced, going from 36.3 to 22.0 for an average reduction of 38.8% (MD 14.3, 95% CI 6.7-14.3). The surgical success rate (defined by Sher et al. as postoperative AHI < 20 and reduction in AHI ≥50%) was 65.4% (95% CI 57%-72%) in the MLS group and 51% (95% CI 32%-70%) in the isolated HS group.

Conclusions: The results of this meta-analysis support the use of hyoid suspension in the treatment of OSA and show that results of hyoid suspension appear to be more consistent when used in combination with palatal-level intervention as part of multilevel sleep surgery.