Effect Of Upper Airway Surgery Research Articles

The Effect of Surgical Therapy for Obstructive Sleep Apnea on Blood Pressure and Peripheral Arterial Tonometry.

To determine the effect of upper airway surgery on cardiovascular function in patients with obstructive sleep apnea (OSA). A prospective, self-controlled study from 2018 to 2023. Two academic medical centers. Seventy-four patients underwent surgery for OSA, including: tonsillectomy, adenoidectomy, epiglottidectomy, modified uvulopalatopharyngoplasty, maxillary expansion, and maxillomandibular advancement. Twenty-four-hour ambulatory blood pressure (BP), peripheral arterial tonometry (PAT)-based home sleep study, and sleep-related patient-reported outcomes (PROs) were captured preoperatively and at 6 months postoperatively. Paired T-tests evaluated changes in outcomes after surgery. Forty-one patients successfully completed preoperative and postoperative assessments. Patients were generally middle-aged (43.8 ± 12.5 years), obese (BMI 33.0 ± 5.8 kg/m2), male (68%), White (71%), and had severe OSA (apnea-hypopnea index [AHI] 33.9 ± 29.5 events/h). The 4% oxygen desaturation index (ODI) decreased from 30.7 ± 27.1 to 12.2 ± 13.6 events/h(P < .01) after surgery. There was no significant difference in 24-hBP following surgery, though clinically meaningful reductions in nocturnal systolic (-1.95 [-5.34, 1.45] mmHg) and nocturnal diastolic (-2.30 [-5.11, 0.52] mmHg) blood pressure were observed. Stratified analysis showed patients undergoing skeletal surgery (n = 17) demonstrated larger average reductions compared to those undergoing soft tissue surgery in nocturnal systolic (-4.12 [-7.72, -0.51] vs-0.10 [-5.78, 5.58] mmHg) and nocturnal diastolic (-3.94 [-7.90, 0.01] vs-0.90 [-5.11, 3.31] mmHg) pressures. No meaningful changes were observed in PAT Autonomic Index (PAI) measurements. Surgical therapy for OSA did not demonstrate statistically significant improvements in 24-hBP. However, clinically meaningful reductions in nocturnal BP were observed, particularly in skeletal surgery patients, supporting the need for larger studies of cardiovascular outcomes following OSA surgery.

White matter microstructure and connectivity changes after surgery in male adults with obstructive sleep apnea: recovery or reorganization?

Obstructive sleep apnea (OSA) is a prevalent clinical problem significantly affecting cognitive functions. Surgical treatment is recommended for those unable to use continuous positive airway pressure. We aimed to investigate the therapeutic effect of upper airway surgery on the white matter (WM) microstructure and brain connectivity in patients with OSA. Twenty-one male patients with moderate-to-severe OSA were recruited for multi-level upper airway surgery. Overnight polysomnography (PSG), neuropsychiatric tests, and brain MRI scans were acquired before and 6.1 ± 0.8 months after surgery. Nineteen male patients with untreated OSA were also included as a reference group. We calculated the longitudinal changes of diffusion tensor imaging (DTI) parameters, including fractional anisotropy (ΔFA) and mean/axial/radial diffusivity (ΔMD/AD/RD). We also assessed changes in network properties based on graph theory. Surgically treated patients showed improvement in PSG parameters and verbal memory after surgery. Globally, ΔFA was significantly higher and ΔRD was lower in the surgery group than in the untreated group. Especially ΔFA of the tracts involved in the limbic system was higher after surgery. In network analysis, higher Δbetweenness and lower Δclustering coefficients were observed in the surgical group than in the untreated group. Finally, the improvement of verbal memory after surgery positively correlated with ΔFA in superior thalamic radiation (p = 0.021), fronto aslant tracts (p = 0.027), and forceps minor tracts (p = 0.032). Surgical treatment of OSA can alleviate alterations in WM integrity and disruptions in local networks, particularly for the tracts involved in the limbic system. These findings may further explain the cognitive improvement observed after the treatment of OSA.

A longitudinal study identifies progressive alterations in brain white matter microstructure and networks in male adults with obstructive sleep apnea and their recovery after sleep surgery (P2-13.005)

<h3>Objective:</h3> We aimed to investigate the effects of surgical treatment on the white matter (WM) microstructure and connectivity. <h3>Background:</h3> Obstructive sleep apnea (OSA) is an increasingly prevalent clinical problem resulting in significant effects on quality of life and cognitive impairments. Surgical treatment is an effective treatment for those unable to use positive airway pressure (PAP), but the therapeutic effect of upper airway surgery on the brain has yet to be determined. <h3>Design/Methods:</h3> Twenty-one male patients with moderate to severe OSA were recruited for multi-level sleep surgery. Overnight polysomnography (PSG), neuropsychiatric tests and brain MRI scans were acquired before surgery and at least 6 months after surgery. Nineteen male patients with untreated OSA were also included as a reference group and with follow-up for 1 year or longer. We calculated the interscan changes of DTI parameters including fractional anisotropy ( FA) in the treated and untreated groups. We also assessed changes in network/connectivity properties based on graph theory. <h3>Results:</h3> Surgically treated patients showed improvement in daytime sleepiness, PSG parameters and verbal memory score after surgery. Globally FA was significantly in the surgical group compared to the untreated group; the untreated group showed disease progression (negative FA) whereas the treated group displayed no progression (near-zero FA). Especially, FA of the tracts involved in the limbic system was higher after surgery. In the analysis of network property metrics, between ness of the right cuneus and frontal pole was significantly higher and clustering coefficient of bilateral post central area was lower in the surgical group compared to the untreated group. <h3>Conclusions:</h3> Surgical treatment of OSA can prevent progressive alterations in WM microstructural integrity and disruptions in local network integration and segregation. The positive effects of surgery were prominent for the tracts involved in the limbic system, which may further explain the cognitive improvement observed after the treatment of OSA. <b>Disclosure:</b> Hea Ree Park has nothing to disclose. Dr. Chai has nothing to disclose. Dr. Joo has nothing to disclose. Prof. Kim has nothing to disclose.

Systematic Review of the Effect of Upper Airway Surgery based on DISE findings in Adults with Obstructive Sleep Apnea

Systematic Review of the Effect of Upper Airway Surgery based on DISE findings in Adults with Obstructive Sleep Apnea

Effects of surgery for obstructive sleep apnea on cognitive function and driving performance.

Obstructive sleep apnea (OSA) is associated with a significantly increased risk of motor vehicle accidents in addition to such cognitive impairments as attention and memory deficits. The aim of the study was to examine the effect of upper airway surgery for OSA on driving and cognitive function. Adult patients who underwent surgery for OSA at a tertiary medical center in 2016-2019 were prospectively recruited. Patients were assessed before and 3-6 months after surgery with a self-report and neurocognitive battery and a driving simulation platform. The cohort included 32 patients of average age 46.9± 11.6 years. During the 3 years before treatment, 9 patients had been involved in road accidents and 18 were detained by police for traffic violations. After surgery, there was a significant decrease in the Epworth Sleepiness Scale (13.7 vs. 8.1, p 0.043) and a significant reduction in time to completion of the Color Trail Test (part 1: 21.4 vs 18.7 s, p = 0.049; part 2: 46.8 vs 40.5 s, p = 0.038). Improvements in divided attention and selective attention response times were noted on the advanced stages of the Useful Field of Vision Scale (p = 0.013, p = 0.054). Before surgery, patients showed a high tendency to drive over the speed limit and to cross the dividing line to the opposite lane on the simulation test. Nevertheless, all considered themselves good drivers. These tendencies decreased after treatment. Surgery for OSA can significantly improve driving performance and cognitive function.

The influence of position-dependency on surgical success in sleep apnea surgery - a systematic review.

To evaluate the influence of position-dependency on surgical success of upper airway (UA) surgery in obstructive sleep apnea (OSA) patients. Systematic review. Two prospective cohort studies and seven retrospective cohort studies were included in this review. Despite the importance of the subject, it remains unclear whether position-dependency is a predictor for surgical success. No differences were found in surgical success rate between non-positional (NPP) and positional (PP) OSA patients undergoing uvulopalatopharyngoplasty/Z-palatoplasty with or without radiofrequent thermotherapy of the tongue, isolated tongue base or multilevel surgery and hypoglossal nerve stimulation. In one study PP undergoing relocation pharyngoplasty had a greater chance of surgical success. In the majority of the remaining studies, surgical success was in favor of NPP. Furthermore, in the vast part of included studies, the effect of UA surgery was suggested to be greater in the lateral position than supine position. Although preoperative characteristics in PP (e.g., lower BMI and AHI) seem to be in favor for higher surgical success compared to NPP, it remains unclear whether position-dependency is a predictor for surgical outcome. It is suggested that the largest differences and expected preoperative and postoperative changes occur in non-supine AHI. In PP, the preoperative non-supine AHI is already lower compared to NPP suggesting a lower chance of surgical success in PP.

The effect of upper airway surgery on the underlying physiological causes of obstructive sleep apnoea

The effect of upper airway surgery on the underlying physiological causes of obstructive sleep apnoea

The Effect of Upper Airway Surgery on Loop Gain in Obstructive Sleep Apnea

Controversy exists as to whether elevated loop gain is a cause or consequence of obstructive sleep apnea (OSA). Upper airway surgery is commonly performed in Asian patients with OSA who have failed positive airway pressure therapy and who are thought to have anatomical predisposition to OSA. We hypothesized that high loop gain would decrease following surgical treatment of OSA due to reduced sleep apnea severity. Polysomnography was performed preoperatively and postoperatively to assess OSA severity in 30 Chinese participants who underwent upper airway surgery. Loop gain was calculated using a validated clinically-applicable method by fitting a feedback control model to airflow. Patients were followed up for a median (interquartile range) of 130 (62, 224) days after surgery. Apnea-hypopnea index (AHI) changed from 60.8 (33.7, 71.7) to 18.4 (9.9, 42.5) events/h (P < .001). Preoperative and postoperative loop gain was 0.70 (0.58, 0.80) and 0.53 (0.46, 0.63) respectively (P < .001). There was a positive association between the decrease in loop gain and the improvement of AHI (P = .025). High loop gain was reduced by surgical treatment of OSA in our cohort. These data suggest that elevated loop gain may be acquired in OSA and may provide mechanistic insight into improvement in OSA with upper airway surgery. Registry: ClinicalTrials.gov, Title: The Impact of Sleep Apnea Treatment on Physiology Traits in Chinese Patients With Obstructive Sleep Apnea, Identifier: NCT02696629, URL: https://clinicaltrials.gov/show/NCT02696629.

The role of drug-induced sleep endoscopy: predicting and guiding upper airway surgery for adult OSA patients.

Obstructive sleep apnea (OSA) is a common sleep disorder that can be corrected with upper airway surgery. Prior to surgery, drug-induced sleep endoscopy (DISE) is routinely used to evaluate obstruction sites and severity. Evidence suggests that the findings of DISE may relate to the final surgical outcome. Therefore, we evaluated the ability of drug-induced sleep endoscopy to predict the final effect of upper airway surgery and potentially to guide surgical treatment decision-making. A retrospective analysis was conducted on 85 adult patients with OSA (50 men with mean apnea-hypopnea index [AHI] 30 ± 15events/h) who underwent DISE followed by tonsillectomy, uvulopalatopharyngoplasty (UPPP), or a combination of the two. Surgery outcome was evaluated at follow-up by polysomnography. Success response to surgery was defined as a postoperative value of the AHI< 20events/h and more than 50% postoperative reduction of AHI. Of the 85 patients evaluated, 48 (53%) were responders. DISE revealed significant differences between the two groups. Specifically, complete circumferential collapse at the velum and complete anterior-posterior collapse at the tongue base occurred at higher frequencies in nonresponders. In contrast, the presence of grade 3-4 tonsillar hypertrophy and anterior-posterior mild/partial collapse at the velum were positively associated with responders. Our results suggest that DISE may help predict the final outcome of tonsillectomy, UPPP, or a combination of the two in adult patients with OSA. The use of DISE shows potential to guide treatment decisions for individual patients with OSA.

Central apneas in children with obstructive sleep apnea syndrome: prevalence and effect of upper airway surgery

BackgroundThe aim of this study is to investigate the prevalence of central sleep apneas syndrome (CSAS) in children with obstructive sleep apnea syndrome (OSAS) and the effect of adenotonsillectomy (A)TE on CSAS. MethodsRetrospective analysis of polysomnographic data in children diagnosed with OSAS and without comorbidity. A central apnea index (CAI) ≥1/h is considered abnormal and central sleep apnea syndrome (CSAS) is diagnosed at a CAI >5/h. Data are presented as median (25–75 percentile). ResultsData were available for 90 children, 35 girls and 55 boys, age 3.7 years (1.8–5.4), BMI-z score 0.20 (−0.85–0.90), oAHI 10.9/h (5.8–19.1). Sixty-four percent had an abnormal CAI and the prevalence of CSAS was 7.8%. There was a significant correlation between CAI and MinSat (r = −0.48, p = 0.01) and between CAI and age (r = −0.45, p = 0.01). Pre-postop PSG data were available for 41 children with a CAI ≥ 1/h. Central apnea index decreased from 2.2/h (1.7–3.8) to 1.3/h (0.8–2.6) (p < 0.001) following (A)TE along with an improvement in oAHI from 10.9/h (5.9–22.2) to 1.2/h (0.6–2.7) (p < 0.001). No patient had postoperative CSAS and a reduction in the CAI <1/h was observed in 11 patients (26,9%). ConclusionA central apnea index ≥1/h is common in children with OSAS but CSAS (CAI >5) is rare. We observed a significant decrease in the CAI and a resolution of CSAS after (adeno)tonsillectomy.

The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis

Background /Aims: The aim of this study was to determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP). A secondary objective was to determine if a decrease in CPAP from UAS increases CPAP adherence. Methods: Studies were eligible for inclusion if a CPAP titration was performed both prior and following UAS in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after UAS were included to evaluate the secondary objective. Results: A total of 11 articles involving 323 patients were included in the review. The results show that there was a mean reduction in CPAP of 1.40 cm H₂O (95% CI -2.08 to -0.73). Four of the 11 papers, with a total of 80 patients, evaluated CPAP adherence and found a significant 0.62-hour improvement on average (95% CI 0.22-1.01). Conclusion: 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 and modestly reduces CPAP while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an adjunctive role in the management of OSA.

Sleep quality change after upper airway surgery in obstructive sleep apnea: Electrocardiogram-based cardiopulmonary coupling analysis.

To test the effect of upper airway surgery on sleep quality in adults with obstructive sleep apnea (OSA) and the potential usefulness of electrocardiogram (ECG)-based cardiopulmonary coupling (CPC) analysis as metrics of sleep quality. Retrospective outcome research. A total of 62 consecutive adult patients with OSA, consisting of 36 with successful and 26 with unsuccessful outcomes, were included in the study. Mean age was 37.7 ± 8.9 years, and body mass index (BMI, kg/m(2) ) was 26.9 ± 2.3. We compared clinical characteristics (age, BMI, and Epworth Sleepiness Scale [ESS]), sleep (sleep efficiency, stage non-rapid eye movement [N]1, N2, N3, rapid eye movement, and arousal index [ArI]), respiratory (apnea index [AI], apnea-hypopnea index [AHI], and minimum arterial oxygen saturation [SaO2 ]), and CPC (high-frequency coupling [HFC], low frequency coupling [LFC], very-low-frequency coupling, and elevated low-frequency coupling [e-LFC]) parameters between the success and nonsuccess groups before and after surgery. Surgical success was defined when the postoperative AHI was both <20 per hour and 50% of the preoperative value. Sleep quality measured by CPC analysis improved significantly (HFC, P = .001; LFC, P = .002; e-LFC, P = .003), along with parallel reduction in ESS, respiratory parameters (AHI, AI, minimum SaO2 ), and sleep fragmentation (ArI) in the group with surgical success after upper airway surgery. Successful upper airway surgery can improve objective sleep quality in adult patients with OSA. CPC metrics of sleep quality are potentially useful to monitor therapeutic responses during long-term postoperative follow-up, as the ECG-based analysis is available as a standalone option outside laboratory polysomnography.

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

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.

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

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 &lt; .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.

Does airway surgery lower serum lipid levels in obstructive sleep apnea patients? A retrospective case review.

BackgroundObstructive sleep apnea (OSA) is tightly linked to increased cardiovascular disease. Surgery is an important method to treat OSA, but its effect on serum lipid levels in OSA patients is unknown. We aimed to evaluate the effect of upper airway surgery on lipid profiles.Material/MethodsWe performed a retrospective review of 113 adult patients with OSA who underwent surgery (nasal or uvulopalatopharyngoplasty [UPPP]) at a major, urban, academic hospital in Beijing from 2012 to 2013 who had preoperative and postoperative serum lipid profiles.ResultsSerum TC (4.86±0.74 to 4.69±0.71) and LP(a) (median 18.50 to 10.90) all decreased significantly post-operatively (P<0.01, 0.01, respectively), with no changes in serum HDL, LDL, or TG (P>0.05, all). For UPPP patients (n=51), serum TC, HDL and LP(a) improved (P=0.01, 0.01,<0.01, respectively). For nasal patients (n=62), only the serum LP(a) decreased (P<0.01). In patients with normal serum lipids at baseline, only serum LP(a) decreased (P<0.01). In contrast, in patients with isolated hypertriglyceridemia, the serum HDL, TG and LP(a) showed significant improvements (P=0.02, 0.03, <0.01, respectively). In patients with isolated hypercholesterolemia, the serum LP(a) decreased significantly (P=0.01), with a similar trend for serum TC (P=0.06). In patients with mixed hyperlipidemia, the serum TC and LDL also decreased (P=0.02, 0.03, respectively).ConclusionsSurgery may improve blood lipid levels in patients with OSA, especially in patients with preoperative dyslipidemia, potentially yielding a major benefit in metabolism and cardiovascular sequelae. Prospective studies should examine this potential metabolic effect of airway surgery for OSA.

Effect of upper airway surgery on heart rate variability in patients with obstructive sleep apnoea syndrome

To determine whether surgery influences cardiovascular autonomic modulation in obstructive sleep apnoea syndrome (OSAS), the present study was performed to evaluate the effect of upper airway (UA) surgery on heart rate variability (HRV) using frequency domain analysis for patient groups who have had either successful or unsuccessful surgery. We compared body mass index (BMI), polysomnographic [apnoea index (AI), apnoea-hypopnoea index (AHI), minimum SaO(2)] and HRV [very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power, HF/LF ratio, LFnu = LF/(LF + HF), HFnu = HF/(LF + HF)] parameters between the unsuccessful (n = 14) and successful (n = 22) surgical groups before and after UA surgery. Significant changes were observed for the successful patient group with respect to mean AI (from 29.1 ± 21.3 to 2.0 ± 3.2 events h(-1), P < 0.001), AHI (from 38.6 ± 20.0 to 5.6 ± 5.1 events h(-1), P < 0.001), minimum SaO(2) (from 73.3 ± 12.7 to 86.3 ± 6.5%, P < 0.001), VLF power (from 25599 ± 12906 to 20014 ± 9839 ms(2), P = 0.013), LF power (from 17293 ± 7278 to 14155 ± 4980 ms(2), P = 0.016), LFnu (from 0.700 ± 0.104 to 0.646 ± 0.128, P = 0.031) and HFnu (from 0.300 ± 0.104 to 0.354 ± 0.128, P = 0.031); however, mean BMI, HF power and LF/HF ratio did not change significantly after UA surgery. No significant changes were observed in the unsuccessful surgical group. Successful UA surgery may improve cardiac sympathetic and parasympathetic modulation in patients with OSAS.

The effect of upper airway surgery on voice.

Our goal was to assess patient perception and acoustic characteristics of voice before and after upper airway surgery. We conducted a prospective assessment of 44 surgical patients preoperatively and postoperatively at a tertiary care, academic hospital. Operations included septoplasty and turbinectomy (n = 28) and septoplasty, turbinectomy, uvulopalatopharyngoplasty, and tonsillectomy (n = 16). Patient opinion measures included Voice Handicap Index score, perception of vocal resonance, and change in voice. Acoustic measures included assessment of the relative amplitude of selected formants (resonances) of the vocal tract. Mean Voice Handicap Index scores were unchanged after surgery. Nine patients (20%) perceived their voice to be improved after surgery. None perceived the voice to be worse. Postoperative changes in relative formant amplitudes were statistically significant. These changes caused the acoustic features to become more representative of normative data than the preoperative values. Upper airway oeprations can affect acoustics and perception of voice. Patients are unlikely to perceive a change in voice as a result of upper airway surgeries, but in those cases where a difference is perceived, it is likely to be a positive change.