P019 Challenging barriers: down under Pharyngoplasty tongue Chanelling when CPAP fails

Aim This study evaluated the efficacy of modified barbed reposition pharyngoplasty (BRP) and coblation tongue channelling (CCT) in adult OSA patients who failed to use CPAP. Additionally, we assessed airway obstruction sites using endoscopy. We propose that Friedman staging is not a reliable predictor of surgical success, suggesting the need for a new prognostic index. Methodology A prospective, 2-centre cohort trial. Polysomnography, Epworth Sleepiness Scale (ESS), and VOTE anatomy assessment were performed preoperatively and 3 months post-surgery. Results 92 had a complete data set with a post-operative sleep study. (74% male; mean age 40.6 ± 12.7 years). Statistically significant improvements were observed in AHI and ESS. Median AHI improved from 27.4 ± 33 to 7.1 ± 11.6 (p=.000), a 65% reduction. Median ESS improved from 12.5 ± 8 to 4 ± 4 (p=.000). Surgical success was achieved in 75% of patients, with 87.6% symptomatically better. 43% were cured. Oxygen Desaturation Index (ODI) reduce from a median of 27.7 +/- 33 to post op median of 4.6 +/- 8.4 (p=.007). Friedman III patients had 76% success rate and 45% cure rate. Using the VOTE classification, the most correctable site of collapse was the oropharynx (100 % reduction of complete collapse), followed by velopharynx (85%), with improvements also noted at the base of tongue (65%). Conclusion Modified BRP with CCT is a safe and effective surgical option for OSA patients who fail CPAP. Traditional poor surgical predictors such as Friedman III stage, Base of tongue collapse and concentric velum collapse are not barriers for BRP.