P100 Modified BRP and Tongue Channelling: Can we cure Friedman III?

AIM: The primary aim of this study was to determine the success rate of modified barbed reposition pharyngoplasty (BRP) and coblation tongue channelling (CCT) in adult patients with obstructive sleep apnoea (OSA). The secondary objective was to determine the anatomical sites that were most amenable to surgical intervention. We predicted that Friedman would be a poor predictor of success for this surgical technique and that a new prognostic index would be required. METHODOLOGY: Adult patients with OSA underwent combined MODIFIED BRP and CCT (n = 40) in this prospective, 2-centre cohort trial. Data analysed included pre- and post-operative (3 months) polysomnography, Epworth sleepiness scale (ESS) and VOTE anatomy assessment (using awake nasoendoscopy) performed by a single investigator. RESULTS: 40 participants have enrolled in this study. So far, 26 patients have pre- and post-operative data. 42% of these patients had Friedman 3 anatomy. Statistically significant decreases in AHI 20.3 + 24 to 4.9 + 8.6 (p=0.001) and ESS 12.4 + 4.9 to 4.8±3.4 (p=0.001) were observed in pre- to post-operative measurements. Friedman stage 3 patients had an 82% surgical success rate and 64% cure rate. Oropharyngeal lateral collapse and velum anteroposterior collapse were the most correctable forms of anatomical collapse. CONCLUSION: MODIFIED BRP with CCT is a safe and effective surgical option for patients with OSA, as indicated by the reduction in AHI and ESS. Friedman stage III is no longer a barrier for surgical success, and therefore a newer staging system is required to help prognosticate success with modern sleep surgery techniques.