Drug-Induced Sleep Endoscopy and Expansion Sphincter Pharyngoplasty Treatment Outcomes

Monday, October 13, 2025

9:54 AM - 10:00 AM EDT

Location: 136

Disclosure(s):

Jaehee Kim, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Elliott M. Sina, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Drug-induced sleep endoscopy (DISE) is utilized to identify airway collapse patterns in obstructive sleep apnea (OSA) and inform surgical planning, though its ability to predict treatment success remains mixed. Expansion sphincter pharyngoplasty (ESP), a surgical technique that repositions and stabilizes the soft palate and lateral pharyngeal walls, has shown promise in treating those with predominantly lateral wall collapse at the oropharynx and velum. However, literature on ESP outcomes tied to specific DISE findings, particularly multilevel obstruction, is sparse. This study examines these associations.

Methods: We conducted a retrospective cohort study of 120 ESP patients (2020-2024) at a single institution. Collected data included patient demographics, DISE findings (VOTE scores, Friedman tongue position (FTP), tonsil size), and sleep study metrics. ESP treatment response was assessed with Sher15 criteria (≥50% AHI reduction to < 15) and post-op AHI reduction to < 15 in patients with pre-op AHI >15. Statistical analyses included chi-squared and paired t-tests on Excel and logistic regression on Prism.

Results: Our ESP cohort (77.3% male, 53.4 ± 9.8 years old) had a BMI of 32.5 ± 4.0 kg/m2, FTP grade of 2.9 ± 0.7, and tonsil hypertrophy grade of 1.5 ± 0.7. AHI decreased from 28.6 ± 15.3 to 11.0 ± 17.1 (p < 0.001) after ESP (38.3% response rate). There were no significant differences in AHI change or Sher15 success among the various configurations and degrees of obstruction. When evaluating treatment response as post-op AHI reduction to < 15, complete or partial epiglottis obstruction (vs. none) was associated with decreased odds of treatment response (39.6% vs. 60.4%, p = 0.037).

Conclusions: ESP is an effective OSA treatment option, as demonstrated by significant post-op AHI reductions. While most DISE-identified obstruction patterns did not predict ESP response, complete or partial epiglottis obstruction lowered the likelihood of achieving a post-op AHI < 15. Addressing epiglottis obstruction during surgical planning and combining ESP with therapies like CPAP or weight management may enhance outcomes.

Presenting Author(s)

Jaehee Kim, BA

Medical Student
Case Western Reserve University School of Medicine
Cleveland, Ohio, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

EZ

Ethan Zheng, BA

Sidney Kimmel Medical College
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
Anne V. Seyferth, BS

Medical Student
Thomas Jefferson University
Philadelphia, PA, United States

Disclosure information not submitted.
Elliott M. Sina, BA

Medical Student
Thomas Jefferson University
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
HI

Henry C. Ideker, MD

Assisant Professor
SLUCare Otolaryngology
St Louis, Missouri, United States

Disclosure information not submitted.
Stephen F. White, MD

Physician
North Atlanta ENT and Allergy
Philadelphia, PA, United States

Disclosure information not submitted.

Senior Author(s)

Colin T. Huntley, MD

Associate Professor
Thomas Jefferson University
Philadelphia, PA, United States

Disclosure information not submitted.