# Edema and Subjective Discomfort After Barbed Stayed Bridge Pharyngoplasty (BSBP)

## TL;DR

A new surgical technique called BSBP reduces sleep apnea symptoms with minimal discomfort and quick recovery, offering a promising alternative to traditional treatments.

## Contribution

The study introduces and evaluates Barbed Stayed Bridge Pharyngoplasty (BSBP) as a novel surgical approach for treating obstructive sleep apnea.

## Key findings

- BSBP significantly reduced AHI and ODI scores in patients with mild to moderate OSA.
- Postoperative pain and edema decreased rapidly, with full recovery observed within a month.
- The PPOPS questionnaire showed significant improvement in patient-reported outcomes over time.

## Abstract

Background: Obstructive Sleep Apnea (OSA) is commonly treated with CPAP, though low patient compliance often limits its long-term use. Surgical alternatives, such as Barbed Pharyngoplasty, have been developed to address retro-velar collapse. A recent technique, Barbed Stayed Bridge Pharyngoplasty (BSBP), aims to preserve oropharyngeal anatomy while enhancing airway stability. This study evaluates the immediate postoperative outcomes and patient discomfort following BSBP for OSA. Material and Method: Thirty patients (mean age 40.7 ± 8.9 years; BMI 25.9 ± 1.7) underwent BSBP at Sapienza University of Rome between January 2022 and January 2024. Inclusion criteria included AHI 15–30, BMI ≤ 35, and specific DISE findings. Postoperative outcomes were evaluated using polysomnographic data (AHI, ODI), the Epworth Sleepiness Scale (ESS), pain scores (VAS), edema grading (Ezzat score), and the PPOPS questionnaire. Follow-ups were performed at 12, 24, and 48 h; 1 month; and 6 months postoperatively. Results: Thirty patients (average age 40.7) with mild to moderate OSA underwent surgery. After six months, there was a significant reduction in AHI (from 23.4 ± 2.1 to 7.2 ± 2.6) and ODI (from 21.0 ± 4.1 to 6.5 ± 2.1), along with a statistically significant improvement in the Epworth Sleepiness Scale. Postoperative pain (VAS) decreased from 3.0 ± 1.5 at 12 h to 0.2 ± 0.5 at one month, and edema (Ezzat score) decreased from 2.0 ± 0.6 at 12 h to 0.0 ± 0.0 at one month, both with significant differences. The PPOPS questionnaire scores remained relatively stable, with mean values of 4.9 ± 2.3 at 12 h, 2.7 ± 1.6 at 24 h, 1.2 ± 1.1 at 48 h, and 0.5 ± 0.7 at one month, showing statistically significant change (p < 0.005). No postoperative bleeding occurred. According to Sher’s criteria, the procedure was consistently effective. Conclusions: BSBP significantly reduces AHI and ODI, demonstrating effective symptom resolution with minimal discomfort and rapid recovery. These results suggest that BSBP may be a viable, less invasive surgical technique for OSA surgeries.