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Redefining the timing of surgery for obstructive sleep apnea in anatomically favorable patients
Author(s) -
Rotenberg Brian W.,
Theriault Jenna,
Gottesman Sophie
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24720
Subject(s) - medicine , continuous positive airway pressure , obstructive sleep apnea , epworth sleepiness scale , septoplasty , apnea–hypopnea index , sleep apnea , anesthesia , surgery , apnea , polysomnography , nose
Objectives/Hypothesis Healthcare remunerating agencies in North America require patients with obstructive sleep apnea (OSA) to undergo a continuous positive airway pressure (CPAP) trial before funding surgical therapy. The adherence rate of CPAP is problematic. This study's objective was to determine the proportion of surgically favorable patients who failed CPAP who subsequently benefitted from surgical therapy, and to explore consideration of surgical therapy as first‐line treatment in this specific OSA subpopulation. Study Design This was a prospective cohort study. Methods Patients with moderate–severe OSA who had failed a minimum 6‐month trial of CPAP were recruited. All had optimal anatomy for surgery and underwent tonsillectomy with palatoplasty ± septoplasty. Outcome measures included apnea‐hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Quality of Life Index (SAQLI‐E), and blood pressure. Patients were followed for 1 year. Results By AHI measurement, 85.7% of patients in the entire cohort were successfully treated by surgery. ESS while on CPAP was 13.7 ± 2.9, improving to 4.1 ± 2.5 after surgery. SAQLI‐E scores on CPAP were 25.7 ± 5.8, improving to 10.2 ± 3.2 after surgery. Blood pressure remained elevated during CPAP but normalized after surgery. All changes were significant at P < .001. Conclusions Surgical intervention improved OSA severity as measured by the ESS, SAQLI‐E, and blood pressure. These measures had not improved on CPAP. AHI improved as well. Our results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence and with only minor surgical risk. Level of Evidence 2 Laryngoscope 124:S1–S9, 2014