{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T03:50:35Z","timestamp":1792986635369,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>We report the results of one-stage multilevel upper airway surgery for patients who could not tolerate continuous positive airway pressure (CPAP). Patients treated with multilevel surgery at a University Hospital in 2015\u20132019 were identified from a prospectively maintained database. The inclusion criteria were aged 18\u201370 years, body mass index (BMI) &lt; 35 kg\/m2, apnea\u2013hypopnea index (AHI) &gt; 20, and lingual tonsil hypertrophy grade 3 or 4. Drug-induced sleep endoscopy was performed before surgery in all patients. Multilevel surgery was performed in one stage and included expansion sphincter pharyngoplasty (ESP), coblation tongue base reduction (CTBR), and partial epiglottectomy (PE) as required. The outcome measures were postoperative AHI, time percentage oxygen saturation &lt; 90%, and Epworth Sleepiness Scale (ESS) score. A total of 24 patients were included: median age 49.1 years, average BMI 27.26 kg\/m2, and 90% men. Ten patients received ESP plus CTBR plus PE, eight received ESP plus CTBR, and six received ESP plus PE. The mean preoperative AHI was 33.01 at baseline and improved to 17.7 \u00b1 13 after surgery (p &lt; 0.05). The ESS score decreased from 11 \u00b1 5.11 to 7.9 \u00b1 4.94 (p &lt; 0.05). The surgical success rate according to Sher\u2019s criteria was 82.3%. The median follow-up was 23.3 months (range 12\u201336). These findings suggest that multilevel surgery is a safe and successful treatment of OSAHS.<\/jats:p>","DOI":"10.3390\/jcm10214822","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T21:29:46Z","timestamp":1634765386000},"page":"4822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["One-Stage Multilevel Surgery for Treatment of Obstructive Sleep Apnea Syndrome"],"prefix":"10.3390","volume":"10","author":[{"given":"Gabriela","family":"Bosco","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"},{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Morato","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"P\u00e9rez-Mart\u00edn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"},{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0593-6257","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Navarro","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2306-8046","authenticated-orcid":false,"given":"Miguel A.","family":"Racionero","sequence":"additional","affiliation":[{"name":"Department of Neumology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-4235","authenticated-orcid":false,"given":"Carlos","family":"O\u2019Connor-Reina","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Quironsalud Marbella, 29603 Marbella, Spain"},{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6601-5331","authenticated-orcid":false,"given":"Peter","family":"Baptista","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Cl\u00ednica Universitaria de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6409-4921","authenticated-orcid":false,"given":"Guillermo","family":"Plaza","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain"},{"name":"Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1002\/lary.27597","article-title":"Multilevel palate and tongue base surgical treatment of obstructive sleep apnea: A systemat-ic review and meta-analysis","volume":"129","author":"Mulholland","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1111\/coa.13213","article-title":"European position paper on drug-induced sleep endoscopy: 2017 update","volume":"43","author":"Ravesloot","year":"2018","journal-title":"Clin. 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Head Neck Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4822\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:19:37Z","timestamp":1760167177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,20]]},"references-count":31,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10214822"],"URL":"https:\/\/doi.org\/10.3390\/jcm10214822","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,20]]}}}