The Effect of Upper Airway Surgery on Sleep Quality and Obstructive Sleep Apnea

Abstract

Objectives: Obstructive sleep apnea (OSA) is a common sleep disorder due primarily to upper airway obstruction. Certain ethnic groups, particularly Chinese, are more susceptible to a severe degree of OSA irrespective of body weight due in part to inherent narrow upper airway anatomy. In this study, we investigated the treatment outcome of combined upper airway surgeries: septoplasty (SP), turbinate reduction (TR), tonsillectomy, and uvulopalatoplasty (UVPP) on OSA in this ethnic group who have clinical identifiable upper airway anatomical obstruction and are unable to tolerate continuous positive airway pressure (CPAP) treatment. Methods: A retrospective study to analyze the effect of either: (1) SP and TR (inferior turbinectomy) only or (2) in combination with UVPP (partial uvulectomy and lateralization of palatal pillars) and standard tonsillectomy, on Chinese patients diagnosed with OSA. Outcome measures were obtained from pre- and postoperative polysomnographs (PSG) where sleep parameters, AHI, and oxygen saturation were analyzed. Results: Patients with only SP and TR (n = 20) failed to produce significant changes in sleep efficiency, sleep arousal (either spontaneous or respiratory related), or AHI measures. Conversely, patients with UVPP and tonsillectomy in combination with TR and SP (n = 16) had nearly 50% reduction or more in all categories of AHI (supine, non-supine, REM, and non-REM) observed ( P < .002). The degree of respiratory arousals was also reduced in this group. Conclusions: The current study supports a greater role of upper airway and palatal surgery as a primary treatment of choice for this ethnic group with definable upper airway obstruction who failed or are unable to tolerate CPAP treatment.