Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery

To evaluate the prognostic role of volume of parapharyngeal fat pad (V ) after multilevel sleep surgery in patients with obstructive sleep apnea syndrome. This retrospective cohort study was conducted in 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent polysomnography (preoperative and postoperative 6 months) and preoperative facial computed tomography with multilevel sleep surgery between May 2010 and February 2019. All patients had failed or refused positive airway pressure treatment. Of the 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent multilevel sleep surgery, 46 were male (92.0%) with mean ± standard deviation age of 41.2 ± 12.5 years. On the preoperative polysomnography, mean ± standard deviation of apnea-hypopnea index and CT90 (cumulative percentage of time spent at oxygen saturation less than 90%) were 43.4 ± 19.3 events/h and 5.6 ± 9.6%, respectively. The average V measured by facial computed tomography scan was 4.9 ± 1.9 cm . Multiple linear regression analysis showed that V was significantly correlated ( = 0.38) with age (β = 0.05; 95% confidence interval [CI], 0.01-0.09) and body mass index (β = 0.31; 95% CI, 0.16-0.45). Surgical success rate was 38%, and V higher than 5.1 cm was significantly associated with surgical failure after covariate adjustment ( .01; odds ratio = 0.09; 95% CI, 0.02-0.48). Postoperative apnea-hypopnea index was positively correlated ( = 0.40) with CT90 (β 1.33; 95% CI, 0.74-1.92) and V (β 3.52; 95% CI, 0.30-6.74). V correlated with age and body mass index, and high V and CT90 were associated with high postoperative apnea-hypopnea index. V larger than 5.1 cm was a possible risk factor for surgical failure, which may inform a decision on multilevel sleep surgery as salvage therapy for positive airway pressure treatment. Kim BK, Park SI, Hong SD, Jung YG, Kim HY. Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery. . 2022;18(12):2819-2828.