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Morbidly Obese Patients With Severe Obstructive Sleep Apnea: Is Airway Reconstructive Surgery a Viable Treatment Option?
Author(s) -
Li Kasey K.,
Powell Nelson B.,
Riley Robert W.,
Zonato Adriane,
Gervacio Lindsay,
Guilleminault Christian
Publication year - 2000
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 - 10.1097/00005537-200006000-00019
Subject(s) - medicine , obstructive sleep apnea , respiratory disturbance index , body mass index , hypoventilation , apnea , obesity , polysomnography , sleep apnea , anesthesia , surgery , positive airway pressure , respiratory system
Objective To evaluate the outcomes of airway reconstructive surgery for the treatment of severe obstructive sleep apnea in the morbidly obese patient. Methods Retrospective review of consecutively treated patients. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), cephalometric data, and complications. Results Twenty‐one patients (13 men) with a mean age of 42.6 ± 7.9 years and mean BMI of 45 ± 5.4 kg/m 2 were identified. The mean RDI improved from 83 ± 30.1 to 10.6 ± 10.8 events per hour with an improved mean apnea index from 38.4 ± 31.3 to 1.2 ± 1.8 events per hour. The mean LSAT improved from 63.9 ± 17.7% to 86 ± 7.9%. The mean BMI at the 6‐month postoperative polysomnographic recording was 43 ± 4.3 kg/m 2 ( P < . 001). Seventeen patients (81%) were successfully treated (RDI < 20 and with minimal desaturation < 90%). The mean follow‐up was 21.8 ± 15.4 months (range, 7–66 mo). Coexisting obesity‐hypoventilation syndrome was related to treatment failure in two patients. One patient noted recurrence of daytime fatigue after significant weight gain 4 years after surgery and the polysomnographic recordings demonstrated the recurrence of obstructive sleep apnea. Conclusion Airway reconstruction is an effective treatment for severe obstructive sleep apnea in the morbidly obese patient. Careful patient selection and identifying potential coexisting obesity‐hypoventilation syndrome, as well as counseling on weight reduction and avoiding continual weight gain will improve treatment outcomes.