CSSC Mornington
Proven Successful outcomes
When success is defined as reducing apnoea below 50% and under 20 events per hour, CSSC has achieved this in over 70% of the patients. "This often-quoted Sher's criteria, based only on numeric values of the PSG test, should be abandoned as they are both insufficient and out of date" (international experts' consensus statement 2024).
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Over 90 % of those who were operated on have had over fifty per cent reduction in their sleepiness and daytime symptoms without the need for any other intervention.
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If surgical benefit is combined with side sleeping or a mandibular advancement splint, CSSC has achieved successful outcomes in over 90% of the cases.
Less than10% needed a CPAP machine after sleep surgery.
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PROSPECTIVE STUDY 2021-2024
(92 patients)
Down under BRP: Friedman 3 no longer a barrier for surgical success (Presented at the 2024 National Conference)
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Aim: Obstructive sleep apnoea (OSA) is a significant health issue with considerable public and personal costs. This study evaluated the efficacy of modified barbed reposition pharyngoplasty (BRP) and coblation tongue channelling (CCT) in adult OSA patients. Additionally, we assessed airway obstruction sites using the Velum, Oropharynx, Tongue base, and Epiglottis (VOTE) classification during awake nasoendoscopy to identify the most correctable types of airway collapse. 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 was conducted to evaluate outcomes of combined modified BRP and CCT in 116 adult OSA patients. Polysomnography, Epworth Sleepiness Scale (ESS), and VOTE anatomy assessment were performed preoperatively and 3 months post-surgery by a single investigator. The results showed significant improvements in sleep quality, daytime alertness, and upper airway anatomy.
Results: The study enrolled 116 participants; 92 had a complete data set. (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 = 0.000), a 65% reduction. Median ESS improved from 12.5±8 to 4±4 (p = 0.000). Surgical success was achieved in 75% of patients, with 87.6% symptomatically better. 43% were cured (AHI < 5 and AHI reduction > 50% from baseline). Oxygen Desaturation Index (ODI) reduced from a median of 27.7 +/- 33 to post op median of 4.6 +/- 8.4 (p =0.007)
Friedman III patients (traditionally difficult anatomy) 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. Friedman stage III anatomy is not a barrier to success. Future studies should investigate new staging systems to better predict postoperative outcomes of modern sleep surgery techniques.
Presented 2025
