Surgical outcomes in a retrospective cohort of adult patients with severe obstructive sleep apnea

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Background: Obstructive sleep apnea (OSA) surgery may improve quality of life, apnea-hypopnea index (AHI) scores and cardiovascular risk parameters. We determined the effect of multilevel upper airway surgery on very severe OSA in continuous positive airway pressure (CPAP) non-adherent patients. Methods: A retrospective cohort of thirty-nine very severe OSA patients [defined by AHI ≥50 or 3% overnight desaturation index (ODI) ≥40] who were non-adherent to CPAP, with surgically-modifiable anatomical traits, were included. Patients were recruited consecutively. All patients underwent multilevel airway reconstructive surgery by a sleep-otolaryngologist Wollongong Hospital and Wollongong Private Hospital in New South Wales, Australia, between January 2009 and December 2018. This included various combinations of lingual and palatine tonsillectomy, Australian modified uvulopalatopharyngoplasty (modified UPPP), radiofrequency-in-saline tongue channelling, trans-palatal advancement pharyngoplasty and midline glossectomy. The primary outcome was changed in AHI. Secondary outcomes included achievement of surgical success (defined as a postoperative AHI <20 and a 50% AHI reduction), changed in 3% ODI, lowest measured oxygen saturations, snoring severity scale, and Epworth sleepiness scale. Statistical analysis was done through SPSS statistics version 21. Results: Of 39 total participants, 31 (79%) were male, with a mean age of 41 years. After surgery, significant improvements were seen in mean AHI [69 to 14, reduction of 55; 95% confidence interval (CI): 48–62, P<0.01]. Twenty-nine (74%) achieved surgical success. There were also improvements in mean 3% ODI [54 to 12, reduction of 41 (95% CI: 32–50)], lowest measured oxygen saturations [73% to 81%, improvement of −9% (95% CI: −17% to −1%, P=0.02)], snoring severity scale (8 to 0.5, P<0.01), and median Epworth sleepiness scale (12 to 4, P<0.01). Conclusions: Non-adherent CPAP patients with very severe OSA may benefit significantly from upper-airway surgery. Patients with severe OSA should be referred to an experienced otolaryngologist for consideration of this surgery, although further prospective studies are needed.

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