Introduction Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), however intolerance is common, creating demand for surgical alternatives. Barbed reposition pharyngoplasty (BRP) suspends the soft palate anterolaterally using knotless barbed sutures. While certain patients may benefit from transpalatal advancement or hypoglossal nerve stimulation, BRP offers a simpler technique with favourable outcomes, particularly when combined with coblation tongue channelling (CCT). Aims To prospectively quantify intraoperative changes in palatal width and height following BRP and evaluate clinical outcomes in CPAP-intolerant OSA patients. Methods Adults aged ≤60 years with an apnoea–hypopnoea index (AHI) ≥5 intolerant of CPAP were prospectively recruited from a Melbourne sleep clinic (2022–2025) and underwent BRP and CCT. Palatal width and height were measured intraoperatively before and after BRP. Outcomes including AHI and Epworth Sleepiness Score (ESS) were reassessed postoperatively and compared using Wilcoxon signed-rank testing. Results 40 patients underwent combined BRP and CCT. BRP increased median palatal width from 2.0 to 3.5cm and reduced palatal height from 3.5 to 2.5cm (both p<0.0001). Median AHI fell from 34.5 to 11.6 (73.1% reduction) and ESS improved from 11 to 3.5 (both p<0.0001). Surgical success (≥50% AHI reduction and AHI ≤20) was achieved in 67.9% of patients, with eight surgical cures (AHI <5). Complications were minor and transient (mild bleeding n=2; suture extrusion n=3). No velopharyngeal insufficiency or tongue morbidity occurred. Conclusions This study is the first to demonstrate the effects of modern palatoplasty on palate and pharyngeal dimensions. BRP widened the pharynx and shortened the palate, improving velopharyngeal patency with significant reductions in AHI and ESS. This anatomy-preserving, low-morbidity technique offers an effective, minimally invasive option for a wide selection of OSA patients.