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Sleep Medicine

(1335) Outcomes and safety of palate pharyngoplasty procedures in OSA: systematic review and meta-analysis

Saturday, October 17, 2026

Presenting Author(s)

Omar W. Azmeh, MS

Clinical Research Fellow
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina
Charleston, South Carolina, United States

Co-Author(s)

Justina Tamer Sargios, BA

Medical student
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina
Charleston, South Carolina, United States

Co-Author(s)

NG

Neeti Gandra, BA

4th Year Medical Student
Medical University of South Carolina/Wayne State University School of Medicine, United States
SN

Shaun A. Nguyen, MD, FAPCR

Professor and Director of Clinical Research
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina
Charleston, South Carolina, United States
Kaitlyn A. Roberts, BS

Clinical Research Fellow
Department of Otolaryngolgoy - Head and Neck Surgery, Medical University of South Carolina
Oxford, Indiana, United States
ST

Shaina Twardus, BA

Medical Student
Medical University of South Carolina, United States

Senior Author(s)

Mohamed A. Abdelwahab, MD, PhD

Assistant Professor
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina
Charleston, SC, United States

Introduction: The aim of this study is to compare the effects of various palate surgeries on AHI and ESS in OSA patients, and to assess bleeding risks across surgeries.

Methods: A systematic search of CINAHL, Cochrane Library, PubMed, and Scopus identified studies of palate surgery for OSA from inception to July of 2025. Procedures included uvulopalatopharyngoplasty (UPPP) and modified variants (mUPPP), anterior or lateral pharyngoplasty (AP or LP), barbed or barbed reposition pharyngoplasty (BP or BRP), expansion sphincter (ESP), preservation (PP), soft palate webbing flap (SPWFPP), and transpalatal advancement (TAP) pharyngoplasties, laser-assisted uvuloplasty (LAUP), radiofrequency-assisted uvulopalatoplasty (RAUP), Z-palatopharyngoplasty (ZPPP), limited palatal muscle resection (LPMR), and uvulopalatal flap (UPF). Extracted outcomes included pre- and postoperative AHI and ESS, and post-operative bleeds, summarized as means, proportions %), and percent AHI and ESS reduction (%). Risk of bias was assessed with the Joanna Briggs Institute (JBI) tool.

Results: Altogether, 261 studies were included (mean age 44.1 years, 95% CI: 43.4-44.9; 84.6% male, 95% CI: 82.7-86.4). Procedures achieving >50% AHI reduction included AP, BP, LP, LPMR, RAUP, SPWFPP, TAP, and UPF, with TAP showing the greatest AHI reduction (73.8%, 95% CI 71–76.6). Procedures producing > 50% ESS reduction included AP, BRP, RAUP, TAP, and ZPPP. RAUP had the highest postoperative bleeding rate at 11.1% (95% CI 4.8–21). RAUP had the highest postoperative bleeding rate at 11.1% (95%CI: 4.8-21).

Conclusions: AP, LP, LPMR, TAP, and RAUP procedures provide the greatest clinically improvements in OSA severity and daytime sleepiness, with RAUP also carrying the highest bleeding risk.