Efficacy and durability of palatal surgery in the treatment of simple snoring: a long-term follow-up study.

PURPOSE: To evaluate the long-term efficacy and durability of barbed anterior pharyngoplasty (BAP) in patients with simple snoring (AHI < 5) and to assess the prognostic value of palatal vibration patterns observed during drug-induced sleep endoscopy (DISE). METHODS: In a prospective cohort study, 37 adult patients with habitual snoring, AHI < 5 on baseline polysomnography, and isolated palatal vibration at DISE were enrolled between 2018 and 2024. Patients were classified according to palatal vibration pattern as concentric (C) or anteroposterior (AP). All subjects underwent standardized BAP. Outcomes at 36 months included Snoring Index (SI), bed partner-reported Visual Analog Scale (VAS) for snoring severity, Epworth Sleepiness Scale (ESS), snoring tolerability, progression to mild OSA (AHI 5-15), adjunctive therapies, and complications. RESULTS: Thirty-seven patients (24 M, 13 F; mean age 44.7 ± 10.2 years) completed 36-month follow-up. Overall, 51.4% achieved ≥ 50% reduction in SI, and 64.9% had improved VAS scores. Improvements were significantly greater in the AP group compared with the C group (SI reduction ≥ 50%: 70.6% vs. 36.8%, p = 0.012; VAS improvement: 76.5% vs. 55%, p = 0.03). Snoring was considered tolerable by bed partners in 51.3% overall (70.6% AP vs. 35.0% C; p = 0.018). Four patients (10.8%) progressed to mild OSA, predominantly in the C group (3/4; p = 0.048). No major complications were observed. CONCLUSION: In patients with simple snoring (AHI < 5), BAP provides durable reduction of palatal vibration and snoring symptoms at three years, particularly in those exhibiting anteroposterior vibration on DISE. DISE-based vibration pattern recognition may improve patient selection; concentric vibration patterns may benefit from alternative or combined approaches.