The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Patient Adherence

Abstract

Objectives: (1) Determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP) pressure by systematic review and meta-analysis. (2) Determine if a decrease in CPAP pressure from UAS could increase CPAP adherence. Methods: A systematic review and meta-analysis was performed. Studies were eligible for inclusion if a CPAP titration was performed both prior and following upper airway surgery in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after upper airway surgery were included to evaluate the secondary objective. Results: A total of 11 articles involving 323 patients were included in the review. There was a mean reduction in CPAP pressure of 1.44 cmH2O [95% confidence interval [CI], –2.09 to 0.78], indicating that UAS reduced CPAP pressure on average. Four of the 11 papers with a total of 80 patients evaluated CPAP adherence. CPAP adherence was improved by 0.62 hours on average [95% CI, 0.22 to 1.01]. Conclusions: CPAP remains the mainstay treatment of moderate to severe OSA, but due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea-hypopnea index, improves symptoms, and modestly reduces CPAP pressure while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an important adjunctive role on the management of OSA.