Long Term Efficacy of Hyomandibular Suspension in the Treatment of Obstructive Sleep Apnea

Introduction: Hyoid suspension has been shown to be effective in the treatment of OSA (Ong et al 2017, Van Tassel et al 2021) however, the long-term efficacy of this procedure has not been examined. This study evaluates hyoid suspension efficacy 5 years or more postop.

Methods: This single center, retrospective study included patients treated for moderate to severe OSA with hyoid suspension who were found to have a sleep study performed at least 5 years postop. 10 patients were treated between 2009 and 2018 with hyomandibular suspension. 4 patients had only hyomandibular suspension. 1 patient had prior uvulopalatopharyngoplasty (UPPP) and midline glossectomy. 3 patients had concurrent UPPP. 2 patients had midline glossectomy one concurrent and the other at a later date. AHI was recorded for the closest preop sleep study within 3 years and then for each successive study. The most recent study was used to calculate the AHI 5+ years postoperatively.

Results: All surgeries and recoveries were without complication.
For all subjects, the mean preoperative AHI was 40.09 and the mean AHI at 5 years or greater postop was 22.2. The preop AHI range was from 15.8 to 96 and the 5 years range was from 1.1 to 49.9. The mean reduction in AHI was 17.9, mean percent reduction in AHI was 44.4%, and mean severity decreased 0.9 classes.
The average time between surgery and the 5 plus years study was 8.1 years.
4 of the 10 subjects had postoperative sleep studies occurring within 1 year postoperatively from hyoid suspension. This group demonstrated an average increase in AHI of 4.15 between their postoperative study and 5+ year study for a rate of a 0.38 per year increase over mean 9.2 years. 2 other patients had sleep studies between 3 and 7 years postop. In all interval studies without further surgical treatment in the interim mean AHI decrease was 0.79 per year.

Conclusions: Hyoid suspension has been demonstrated to be effective in the treatment of OSA. This study suggests that hyoid suspension remains effective in the treatment of OSA for greater than 5 years postoperatively and demonstrates less decline in effectiveness over time compared to UPPP alone (He et al 2019).