Postoperative Apnea-hypopnea Index Research Articles

Comparative effectiveness of hypoglossal nerve stimulation and alternative treatments for obstructive sleep apnea: a systematic review and meta-analysis.

Continuous positive airway pressure (CPAP) is the primary therapeutic modality for obstructive sleep apnea (OSA) management. However, despite efforts to encourage patients to comply with CPAP usage, long-term adherence remains low. Consequently, surgical intervention for OSA is considered a secondary option for patients who exhibit non-compliance with CPAP. Therefore, we conducted systematic review and meta-analysis assessed the relative effectiveness of hypoglossal nerve stimulation (HNS) treatment and alternative surgical interventions for managing OSA. Five databases were searched. Studies were included if they measured polysomnography parameters and assessed sleep apnea-related quality of life (Epworth Sleepiness Scale [ESS]) both before and after HNS, and compared these outcomes with control, CPAP, or airway surgery (uvulopalatopharyngoplasty, expansion sphincter pharyngoplasty, or tongue base surgery) groups. A total of 10 studies (2209 patients) met the inclusion criteria. Compared to other airway surgeries, the rates of post-treatment apnea-hypopnea index (AHI) < 10 and < 15 events/h were significantly lower in the HNS group (odds ratio [OR] 5.33, 95% confidence interval [CI] 1.21-23.42; and 2.73, 95% CI 1.30-5.71, respectively). Additionally, postoperative AHI was significantly lower in the HNS group than in all other airway surgery groups (AHI: mean difference [MD] -8.00, 95% CI -12.03 to-3.97 events/h). However, there were no significant differences in the rate of post-treatment AHI < 5 events/h (OR 1.93, 95% CI 0.74-5.06) or postoperative ESS score (MD 0.40, 95% CI-1.52 to 2.32) between the two groups. HNS is an effective option for selected patients with moderate-to-severe OSA and CPAP intolerance.

Fluoroscopic-Assisted Tongue Suspension: Advancement and Innovation in the Management of Complex Pediatric Obstructive Sleep Apnea.

The primary aim of this study is to describe a novel surgical technique developed for tongue base suspension (TBS). The second aim of this study is to assess the efficacy of the developed procedure by quantifying preoperative and postoperative polysomnographic outcomes for pediatric patients undergoing fluoroscopic-assisted tongue suspension (FATS) with the Encore System. Our hypothesis is that our FATS technique will provide at least a 50% reduction in the Apnea/Hypopnea Index (AHI), including in the medically complex pediatric population. Retrospective case series. An electronic medical record review was conducted of patients who underwent FATS by a single surgeon at a tertiary care medical center between December 2019 and June 2022. Inclusion criteria included all patients <18 years old with evidence of OSA or sleep-disordered breathing and who had glossoptosis on sleep endoscopy. Data extracted from the medical record included age, gender, medical comorbidity history, reason for referral, history of airway surgeries, length of hospital stay, surgical complications data, and preoperative and postoperative polysomnographic data. Surgical success was defined by at least a 50% reduction in AHI. Thirty patients (53.3% male) with a mean age of 6.3 (±5.3, 0.16-17) years underwent FATS over the study period. Most patients (93%) had an underlying comorbidity: cerebral palsy (37%), chromosomal abnormalities (23%), Down syndrome (13%), Pierre-Robin sequence (10%), and obesity (10%). The majority of patients (77%) were explicitly referred for tracheostomy placement secondary to failed management of OSA. 21 patients completed both preoperative and postoperative polysomnograms. The mean preoperative AHI, obstructive AHI (oAHI), and respiratory disturbance index (RDI) were 28.8 (±19.8), 30.8 (±19.6), and 30.5 (±19.3), respectively. The mean postoperative AHI, oAHI, and RDI were 7.3 (±9.2), 7.5 (±9.1), and 7.9 (±9.3), respectively. The mean change in AHI was -21.5 (±21.4) events/h (p < 0.01, 95% CI -29.0 to -11.4 events/h). The mean percentage decrease in AHI was 74.7%. The mean change in oAHI and RDI were -23.3 (±21.9) events/h (p < 0.01 95% CI- 39.9 to -21.4 events/h) and -22.5 (±21.5) events/h (p < 0.01, 95% CI- 31.5 to -12.4 events/h), respectively. The mean percentage decrease in oAHI and RDI was 75.6% and 73.8%, respectively. Surgical success occurred in 16 of the 21 (76%) patients. Of the 23 patients referred explicitly for tracheostomy placement, 21 (91%) were able to avoid tracheostomy placement secondary to improvements in OSA. Patients undergoing fluoroscopic-assisted TBS revealed statistically significant improvements in AHI, oAHI, and RDI, with an overall surgical success rate of 76%. Complication rates were minimal, despite the complex nature of the study population. FATS should be considered a viable surgical approach in pediatric patients with an identified base of tongue obstruction and OSA. 4 Laryngoscope, 134:S1-S9, 2024.

Increased Body Mass Index Correlates with Less Favorable Postoperative Outcomes After Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: A Retrospective Cohort Study

Obstructive sleep apnea is associated with high morbidity. Hypoglossal nerve stimulation (HNS) has become a novel (neuro-) surgical treatment strategy for obstructive sleep apnea, demonstrating good success rates. Beyond predefined inclusion and exclusion criteria, no precise data are available, enabling individual preoperative risk assessment. To improve preoperative risk stratification, this study analyzed individual patient factors that affect outcomes of HNS. Fourteen patients treated with unilateral HNS were analyzed retrospectively. Assessed risk factors included: hypertension, diabetes mellitus, depression, smoking, alcohol consumption, body mass index (BMI), and disease duration. Treatment success was defined as a reduction in the postoperative apnea-hypopnea index (AHI) to≤20 events/hour, with a relative reduction of at least 50% compared to baseline. A significant reduction in the postoperative apnea-hypopnea index was observed in all patients (P < 0.0001). BMI correlated significantly with postoperative AHI scores (95% confidence interval, 0.1519-0.8974; P= 0.018). Significant treatment success was observed in 50% of patients. Compared with the "Excellent Responder group," the "Responder group" demonstrated a significantly higher BMI (95% confidence interval, 1.174-6.226; P= 0.0078). Diabetes, hypertension, disease duration, smoking, depression, and alcohol consumption were not significantly associated with AHI reduction. Our findings suggest that BMI may be an independent risk factor for the response to HNS, with patients who had less benefit from therapy having significantly higher BMI than "Excellent Responders." Therefore, carefully selecting patients is crucial in obtaining optimal outcomes with HNS therapy, especially those with a high BMI.

Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea.

Prior studies have demonstrated the efficacy of lingual tonsillectomy in treating pediatric obstructive sleep apnea. The goal of this study is to describe the postoperative outcomes following lingual tonsillectomy as a part of drug-induced sleep endoscopy-directed multilevel sleep surgery. A retrospective review was performed for pediatric patients with obstructive sleep apnea who underwent lingual tonsillectomy as a part of drug-induced sleep endoscopy-directed sleep surgery. Data collected included age, sex assigned at birth, body mass index z-score, polysomnography results, past medical and surgical history, and postoperative outcomes. A total of 174 patients were included in the study with a mean age of 8.29 ± 3.49 years (range 1.89-15.62) and mean preoperative apnea-hypopnea index of 7.88 ± 13.42 (range 1.10-123.40). Complications occurred in 26 patients (14.9%) including 14 patients (8.0%) requiring emergency department visit or readmission and 12 patients (6.9%) experiencing postoperative bleeding. Asthma (P = .033) and developmental delay (P = .016) correlated with postoperative complications. For patients with preoperative and postoperative polysomnography data (n = 145; 83.3%), there was significant improvement (P < .001) in apnea-hypopnea index with a mean postoperative apnea-hypopnea index of 4.02 ± 7.81 (range 0.00-54.46). Surgical failure, defined as postoperative apnea-hypopnea index ≥ 5, was identified in 25 patients (17.2%). Surgical failure was associated with body mass index z-score > 2 (P = .025) and Trisomy 21 (P = .005). This study highlights the promising surgical success rate of drug-induced sleep endoscopy-directed lingual tonsillectomy in multilevel sleep surgery (82.8%) and infrequent complications including postoperative bleeding (6.9%) and readmission (2.3%). Williamson A, Morrow VR, Carr MM, Coutras SW. Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea. J Clin Sleep Med. 2024;20(2):189-199.

Feeding Outcomes After Mandibular Distraction for Airway Obstruction in Infants.

Robin sequence is a congenital issue resulting in airway obstruction, difficulty feeding, and failure to thrive. Mandibular Distraction Osteogenesis is used to improve airway obstruction in these patients, but little data exists characterizing feeding outcomes following surgery. This study aims to evaluate feeding outcomes and weight gain following mandibular distraction for airway correction in infants. A single-center retrospective chart review was conducted, and patients under 12 months old who underwent mandibular distraction between December 2015 and July 2021 were included in the study. The presence of cleft palate, distance of distraction, and polysomnography results were recorded. The primary outcomes were the length of distraction, need for nasogastric tube or G-tube at discharge, time lapsed to achieve full oral feeds, and weight gain (kilogram). Ten patients met the criteria. Of those 10 patients, 4 were syndromic, 7 had a cleft palate, and 4 had a congenital cardiac diagnosis. The average length of stay postsurgery was 28 days. Eight patients achieved full oral feeds in an average of 65.6 days. Five patients required nasogastric tube or G-tube at discharge, with 3 of these patients later transitioning to full oral feeds. All patients gained weight 3 months postsurgery with an average of 0.521kg/mo. Patients who achieved full oral feeds gained an average of 0.549kg/mo. Patients with supplementation gained an average of 0.454kg/mo. All patients demonstrated improvement in airway obstruction with an average postoperative apnea hypopnea index of 1.64. Further investigation is necessary to identify challenges seen in feeding after mandibular distraction osteogenesis and improve care.

Efficacy and safety of adenotonsillectomy in the management of obstructive sleep apnea syndrome in children with Down syndrome: A systematic review and meta-analysis.

Obstructive sleep apnea (OSA) is commonly observed in children with Down syndrome (DS) and may affect their physical and psychological development. Currently, adenotonsillectomy is the first line treatment option for paediatric patients with OSA. However, surgical outcomes for such patients are not satisfactory. In this study, we analysed the efficacy and safety of adenotonsillectomy in the treatment of children with obstructive sleep apnea and Down syndrome. We systematically searched the PubMed, Web of Science, EMBASE, and the Cochrane databases and pooled data from nine relevant studies involving 384 participants. Subsequently, we analysed four outcomes in polysomnography, namely: net postoperative changes in the apnea-hypopnea index (AHI), the minimum oxygen saturation, sleep efficiency, and arousal index. Meta-analysis of the AHI showed a decrease of 7.18 events/h [95% CI (-9.69, -4.67) events/h; p < 0.00001] and an increase in the minimum oxygen saturation of 3.14% [95% CI (1.44, 4.84) %; p = 0.0003]. There was no significant increase in sleep efficiency [MD 1.69%, 95% CI (-0.59, 3.98) %; p = 0.15], but the arousal index significantly decreased by -3.21 events/hour [95% CI (-6.04, -0.38) events/h; p < 0.03]. In addition, the overall success rate was 16% (95% CI, 12%-21%) for postoperative AHI < 1 and 57% (95% CI, 51%-63%) for postoperative AHI <5. The postoperative complications recorded included airway obstruction and bleeding. This study demonstrated the efficacy of adenotonsillectomy as a treatment option for OSA. However, it is important to note that residual OSA and potential postoperative complications require further attention in future studies.

Role of ApneaGraph® in the Surgery for Obstructive Sleep Apnoea.

To evaluate the utility of ApneaGraph® AG 200 in diagnosing Obstructive Sleep Apnoea (OSA) as compared to Polysomnography, localization of the site of upper airway obstruction, and the success rate of surgery. A prospective study was conducted including fifteen patients of OSA undergoing surgical treatment. All patients underwent sequential overnight ApneaGraph (AG) and Polysomnogram (PSG) before and after 3 months following surgery. The preoperative and post-operative Apnoea-Hypopnoea Index (AHI) values were compared between AG and PSG. The success of surgery was defined as mean reduction in AHI by ≥ 50% and post-operative AHI < 20. The mean preoperative AHI using PSG was 53.7 and using AG was 44.9 (r = 0.83, p = 0.0001). All patients underwent AG-directed site-specific surgery. The mean postoperative AHI using PSG was 15.3 and using AG was 13.8 (r = 0.67, p = 0.0062). There was significant improvement in AHI post-surgery (p < 0.05, AG & PSG). The surgical success was achieved in 93.3%. The median follow-up was 14 months. ApneaGraph is a reliable alternative to PSG to diagnose OSA with an added advantage to localize the site of obstruction, yielding good surgical outcomes.

Tonsil volume and outcome of radiofrequency uvulopalatoplasty with or without tonsillectomy in adults with sleep-disordered breathing

PurposePredictors for the outcome of uvulopalatopharyngoplasty with and without tonsillectomy (UPPP ± TE) in sleep-disordered breathing have not been fully established. This study investigates tonsil grade, volume, and preoperative examination in predicting radiofrequency UPP ± TE outcomes.MethodsAll patients undergoing radiofrequency UPP with tonsillectomy if tonsils were present between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical examination, including Brodsky palatine tonsil grade from 0 to 4. Preoperatively and 3 months after surgery, sleep apnea testing was performed using respiratory polygraphy. Questionnaires were administered assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) and snoring intensity on a visual analog scale. Tonsil volume was measured intraoperatively using water displacement.ResultsThe baseline characteristics of 307 patients and the follow-up data of 228 patients were analyzed. Tonsil volume increased by 2.5 ml (95% CI 2.1–2.9 ml; P < 0.001) per tonsil grade. Higher tonsil volumes were measured in men, younger patients, and patients with higher body mass indices. The preoperative apnea–hypopnea index (AHI) and AHI reduction strongly correlated with tonsil volume and grade, whereas postoperative AHI did not. The responder rate increased from 14% to 83% from tonsil grade 0 to 4 (P < 0.01). ESS and snoring were significantly reduced after surgery (P < 0.01), but the reduction was not influenced by tonsil grade or volume. No other preoperative factor other than tonsil size could predict surgical outcomes.ConclusionsTonsil grade and intraoperatively measured volume correlate well and predict the reduction of AHI, while they are not predictive of ESS and snoring response after radiofrequency UPP ± TE.

Effect of surgical intervention on serum Insulin-like growth factor-1 in patients with obstructive sleep apnoea.

To evaluate the effect of surgical intervention on serum insulin-like growth factor 1 levels in patients with obstructive sleep apnoea. A prospective study was conducted in a tertiary care hospital of adult patients with obstructive sleep apnoea for whom continuous positive airway pressure therapy failed or was refused. All patients underwent polysomnography and serum insulin-like growth factor 1 evaluation pre-operatively and at three months post-operatively. The site of surgery was determined using Müller's manoeuvre and ApneaGraph AG 200. Fifteen patients were included with a mean age of 38 years: 11 males and 4 females. The mean pre-operative Apnoea-Hypopnoea Index using polysomnography was 53.7 events per hour, and the mean post-operative Apnoea-Hypopnoea Index at three months was 15.3 events per hour (p = 0.0001). The mean pre-operative serum insulin-like growth factor 1 was 160.2 μg/l, while the mean post-operative value was 236.98 μg/l (p = 0.005). In adult patients with obstructive sleep apnoea for whom continuous positive airway pressure therapy fails, site-specific surgical intervention to treat the obstruction leads to an increase in serum insulin-like growth factor 1 levels.

Supine Pharyngeal Width Is Associated With Complete Concentric Palatal Collapse During Drug-Induced Sleep Endoscopy and Hypoglossal Nerve Stimulator Outcomes.

Hypoglossal nerve stimulation (HNS) implantation in the US requires preoperative drug-induced sleep endoscopy (DISE) screening for complete concentric palatal collapse (CCC) to establish treatment candidacy. We hypothesized that supine pharyngeal width (SPW) in awake patients is associated with CCC and HNS therapy outcomes. Adults with moderate to severe obstructive sleep apnea underwent awake measurement of SPW followed by DISE screening for CCC. Eligible patients electing for HNS implantation underwent postoperative polysomnography per standard of care. SPW was measured in 73 patients. For SPW >20mm, the positive likelihood ratio for absence of CCC was 6.67 with pre- and post-test odds of 6.3 and 42.0, respectively. Postoperative PSG data were available from 31 of 44 (70.5%) patients subsequently implanted with HNS. Patients with SPW >20mm had a greater rate of HNS response than those with SPW ≤20 (62 vs 30%; P < .05). Only SPW and BMI were significantly associated with CCC and HNS response in regression models. In a retrospective cohort study, SPW was significantly associated with CCC and postoperative apnea-hypopnea index following HNS implantation. SPW may be a viable screening tool for HNS candidacy.

Surgical Outcomes for Obstructive Sleep Apnea in Korea

Obstructive sleep apnea (OSA) is a common chronic sleep disorder that causes oxygen desaturations, sympathetic hyperactivation, and sleep fragmentation. The gold standard for OSA treatment in adults is positive airway pressure (PAP) therapy, which is effective when used during sleep. However, about half of patients with OSA refuse or are non-adherent to PAP, and some patients have anatomical problems that can be alleviated surgically. Surgery can be considered for patients who are very likely to have successful surgical results, but who are intolerant to PAP or oral appliances because of anatomical abnormalities. There are various surgical modifications of the upper airway for OSA, including nasal surgeries (e.g., septoplasty, turbinoplasty, and endoscopic sinus surgery), nasopharyngeal surgeries, oral and oropharyngeal surgeries (e.g., uvulopalatopharyngoplasty and variations, tonsillectomy, and palatal implants), hypopharyngeal surgeries (e.g., tongue ablation, tongue-base resection, and genioglossus advancement), and multi-level surgeries. Much clinical research has reported the outcomes of various surgical procedures for OSA internationally based on the traditional surgical success rate (defined as ≥ 50% reduction in the postoperative apnea-hypopnea index [AHI], postoperative AHI &lt; 20), and AHI reduction ratio (defined as between the preoperative and postoperative AHI). In addition, many studies investigating the results of various OSA surgeries have been reported in Korea. In this article, we review the characteristics of various upper airway surgical procedures for OSA, global surgical results for OSA, and current surgical outcomes for OSA in Korea.

Impact of free flap reconstruction on obstructive sleep apnea in patients with oral and oropharyngeal cancer

ObjectiveLittle is known about the association between obstructive sleep apnea (OSA) and oral and oropharyngeal cancers (OOCs). This study aims to investigate the incidence and severity of OSA in patients with OOCs before and 6 months after free flap reconstruction (FFR), as well as identify the factors that affect the severity of OSA. MethodsA prospective cohort study was designed. We recruited patients aged ≥ 20 years who were newly diagnosed with OOC and underwent FFR surgery at a medical center. Demographic data, cancer characteristics, and objective full-night polysomnographic parameters were collected. The Spearman rank correlation coefficient or the Kruskal–Wallis test was used for analyses. ResultsIn the 23 included patients, the incidence of OSA was 91.3% before surgery and 95.6% as of 6 months after surgery. The proportion of patients with moderate OSA (apnea-hypopnea index (AHI) 15–29) or severe OSA (AHI ≥ 30) had increased from 52.2% to 78.3%, and the AHI was significantly increased (23.3 ​± ​17.6 vs. 34.6 ​± ​19.3, P ​= ​0.013) as of 6 months after surgery. Neck circumference and treatment type were significantly correlated with preoperative and 6-month postoperative AHI, respectively. ConclusionsPatients with OOCs had a high incidence of OSA before and after surgery. OOC survivors should undergo early OSA assessment and receive pre- and post-FFR OSA management to improve their quality of life.

Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery.

To evaluate the prognostic role of volume of parapharyngeal fat pad (VPPFP) after multilevel sleep surgery in patients with obstructive sleep apnea syndrome. This retrospective cohort study was conducted in 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent polysomnography (preoperative and postoperative 6 months) and preoperative facial computed tomography with multilevel sleep surgery between May 2010 and February 2019. All patients had failed or refused positive airway pressure treatment. Of the 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent multilevel sleep surgery, 46 were male (92.0%) with mean ± standard deviation age of 41.2 ± 12.5 years. On the preoperative polysomnography, mean ± standard deviation of apnea-hypopnea index and CT90 (cumulative percentage of time spent at oxygen saturation less than 90%) were 43.4 ± 19.3 events/h and 5.6 ± 9.6%, respectively. The average VPPFP measured by facial computed tomography scan was 4.9 ± 1.9 cm3. Multiple linear regression analysis showed that VPPFP was significantly correlated (R2 = 0.38) with age (β = 0.05; 95% confidence interval [CI], 0.01-0.09) and body mass index (β = 0.31; 95% CI, 0.16-0.45). Surgical success rate was 38%, and VPPFP higher than 5.1 cm3 was significantly associated with surgical failure after covariate adjustment (P = .01; odds ratio = 0.09; 95% CI, 0.02-0.48). Postoperative apnea-hypopnea index was positively correlated (R2 = 0.40) with CT90 (β = 1.33; 95% CI, 0.74-1.92) and VPPFP (β = 3.52; 95% CI, 0.30-6.74). VPPFP correlated with age and body mass index, and high VPPFP and CT90 were associated with high postoperative apnea-hypopnea index. VPPFP larger than 5.1 cm3 was a possible risk factor for surgical failure, which may inform a decision on multilevel sleep surgery as salvage therapy for positive airway pressure treatment. Kim BK, Park SI, Hong SD, Jung YG, Kim HY. Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery. J Clin Sleep Med. 2022;18(12):2819-2828.

Hypoglossal nerve stimulator patient usage: Patterns and trends over time.

ObjectiveHypoglossal nerve stimulation (HNS) is an effective treatment for obstructive sleep apnea (OSA) patients intolerant of continuous positive airway pressure but is only effective if used regularly. Usage patterns have not been studied in detail. In this study, we aimed to characterize granular HNS usage patterns.MethodsPatients implanted by a single surgeon at an academic medical center from August 2016 to January 2021 were identified from a prospective database, which was merged with the Inspire Cloud usage database. Patient, OSA, and usage characteristics were summarized, and patient‐ and OSA‐related characteristics were associated with usage characteristics by Wilcoxon rank‐sum analyses. Usage trends over time were summarized in the overall cohort and stratified by initial usage.ResultsFifty patients were included. Median usage was 94% of nights (interquartile range [IQR]: 82%–98%) for 5.8 h per night (IQR: 4.9–6.4). Higher post‐operative apnea–hypopnea index predicted fewer nights used (92% [IQR: 82%–97%] vs. 96% [IQR: 91%–99%]). No other characteristics examined were significantly associated with usage. Median hours used per night decreased from 6.80 h (IQR: 5.32–7.94) on Day 1 to 5.76 (IQR: 1.81–7.13) on Day 361. This decrease was most pronounced in the quartile with the lowest initial usage.ConclusionThis study found that most patient and OSA characteristics were not associated with HNS usage, and that usage generally decreased over time. This decrease in usage over time was most pronounced in patients with the lowest initial usage. Further work should identify interventions to improve usage patterns to optimize clinical outcomes. Level of Evidence: 4.

The impact of thyroidectomy on obstructive sleep apnea: a systematic review and meta-analysis.

Various thyroid pathologies are speculated to contribute to obstructive sleep apnea (OSA). The underlying mechanisms of the intricate relationship between OSA and thyroid structure and function, and whether thyroidectomy can alleviate OSA symptoms remain unclear. An assessment of the impact of thyroidectomy on OSA is warranted. A systematic review of four electronic databases (PubMed (Medline), Embase, the Cochrane library, and ClinicalTrials.gov) was performed up to February 2022. The primary outcomes were preoperative and postoperative Apnea/Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Berlin questionnaire scores, and continuous positive airway pressure (CPAP) use. A meta-analysis of continuous measures and odd ratios was conducted. Small-scale studies underwent a qualitative meta-analysis. Six cohort studies on 221 OSA patients who underwent thyroidectomies were included. The results showed that thyroidectomy was associated with significant reduction in postoperative AHI (Mean difference [MD], -6.39, 95% CI, -12.46 to -0.32), however, no significant association was found with CPAP withdrawal (Odd ratio [OR], 0.38, 95% CI, 0.12-1.18). Neither the Berlin questionnaire score (OR, 0.19, 95% CI, 0.03-1.17) nor the ESS improved postoperatively (MD, -1.04, 95% CI, -6.37 to 4.29). This meta-analysis provides a quantitative estimate for the effect of the thyroidectomy on OSA and suggests that thyroidectomy is associated with limited clinical improvement of polysomnographic measures. Future large-scale, well-designed prospective studies are necessary to validate these findings and to refine accordingly the preoperative assessment of both medical conditions individually and in combination.

Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA

Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. All participants underwent CBCT and PSG before and after adenotonsillectomy. Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, -10.24 events per hour; 95% CI, -13.84 to -6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm3; mean difference, 3896.6 mm3; 95% CI, 2788.0 to 5005.2 mm3), nasopharyngeal volume (from 2366 to 3826 mm3; mean difference, 1459.7 mm3; 95% CI, 1122.9 to 1796.5 mm3), minimal nasopharyngeal airway area (from 128 to 191 mm2; mean difference, 63.1 mm2; 95% CI, 47.4 to 78.8 mm2), mean nasopharyngeal airway area (from 144 to 231 mm2; mean difference, 86.8 mm2; 95% CI, 67.0 to 106.5 mm2), oropharyngeal volume (from 8898 to 11 335 mm3; mean difference, 2436.9 mm3; 95% CI, 1477.0 to 3396.8 mm3), minimal oropharyngeal airway area (from 82 to 158 mm2; mean difference, 76.2 mm2; 95% CI, 57.0 to 95.4 mm2), and mean oropharyngeal airway area (from 182 to 234 mm2; mean difference, 52.5 mm2; 95% CI, 33.6 to 71.4 mm2). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.

0333 Gender and Menopausal Status Correlate with Sleep Surgery Outcome

Abstract Introduction With recognized anatomic and physiological differences between males and females, it is critical to describe outcomes of sleep surgery with respect to gender. The objective of this study is to compare the subjective and objective outcomes of phase I sleep surgery with respect to gender and age. Methods This was a retrospective review of adult subjects who presented to a single center for surgical evaluation of OSA from January 2019 to June 2021. Only subjects undergoing phase I surgery (turbinate reduction, septoplasty, nasal valve surgery, DOME, tonsillectomy, preservation palatopharyngoplasty, tongue base reduction, genioglossus advancement, and upper airway stimulation), who also had complete pre and post-operative PSG data were included. Objective measures were post operative apnea hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturations (LOS). Subjective outcomes include Epworth Sleepiness Scale (ESS), and Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires. The groups were matched for age and pre-operative BMI. Results Twenty-six subjects met inclusion criteria, of which 12 were female and 13 were males. Of the females 5 were post-menopausal. The average male pre-operative AHI, ODI, lowest SpO2, and ESS were 34.4± 28.7, 30.2±28.3, 80.7±6.6, and 10.3±5.6 respectively. Pre-operative values for females were, 31.9±19.2, 18.47±20.4, 82.8±8.4, and 12.5±4.8 respectively. The average AHI reduction in males was 25.5± 29.1, and for females it was 8.3±21.0 (p=0.042). Specific to post-menopausal females, Average AHI reduction was 8.3± 21.0 and 20.2±16.6 for pre-menopausal females (p=0.01). The average ESS reduction in males was 3.1±3.2 (p=0.22) and for females 5.5±5.4 (p=0.001). Conclusion In this cohort, pre-menopausal women have higher objective surgical success rate (Sher’s criteria) after phase I surgery as compared to post-menopausal women. Men respond more favorably than women to phase I surgery based on AHI reduction, but not with ESS. Gender and menopause status are important factors in evaluating efficacy of sleep surgery. Support (If Any)

Bimaxillary Orthognathic Surgery Does Not Induce Obstructive Sleep Apnea in Skeletal Class III Patients

Since the relationship between mandibular setback surgery and obstructive sleep apnea (OSA) occurrence still remains controversial, the aim of this study was to assess the impact of bimaxillary orthognathic surgery on the probability of OSA development, using a home sleep test (HST) device. The authors implemented a double-blinded prospective cohort study. All healthy patients with skeletal class III deformity were included in this study. Subjects were candidates for bimaxillary orthognathic surgery. OSA monitoring was performed by the pulmonologist, week 1 preoperatively (T0), 1 and 6months postoperatively (T1, T2), with a specific brand of a HST device. The predictor variables were the amount of mandibular setback and maxillary advancement, separately. Changes in apnea-hypopnea index (AHI) and SpO2 1 and 6months after surgery relative to T0 were the outcome variables. OSA severity was measured using AHI, and classified as mild (5<AHI<15), moderate (15<AHI<30), and severe (AHI>30). Age, sex, and body mass index were the study covariates. The outcome assessor (pulmonologist), and the data analyzer were blind in this study. The significance level was set at 0.05, using the SPSS19. The sample was composed of 30 patients, (15 females, 15 males) with an average age of 25.73±5.26years and a mean body mass index of 19.90±3.6kg/m2. The mean amount of mandibular setback was 4.5±1.1 (ranged from 2-7mm), while the average maxillary advancement was 2.9±1.2mm (ranged 1-5mm). Mean AHI at T0, T1, and T2 was 1.8±1.0, 3.4±1.5, and 1.9±0.9 events per hour events, respectively. The AHI scores increased from T0 to T1 but again decreased until T2, which were statistically significant (P<.001). The mean amount of SpO2 at T0, T1, and T2 was 96.7±0.9, 94.0±1.3, 96.7±0.7%, respectively. Postoperative AHI in T1 and T2 had direct statistical significant relationships with the amount of mandibular setback (Rsp=.404, .574, respectively and P<.05). Postoperative AHI scores were lower in patients with <5mm mandibular setback in comparison to subjects who underwent ≥5mm setback (P<.05). Bimaxillary orthognathic surgery (concomitant maxillary advancement and mandibular setback) did not increase the incidence of OSA in young healthy non-obese class III patients, in the case of mandibular setback up to 7mm.

Clinical Predictors of OSA Treatment Success Following Implantation of a Hypoglossal Nerve Stimulation Device.

To identify prognostic indicators associated with successful hypoglossal nerve stimulation (HGNS) therapy to treat obstructive sleep apnea (OSA), focusing on patients' physiologic response to awake tongue protrusion. Retrospective chart review. Tertiary care center. We included consecutive patients with moderate-severe OSA who underwent HGNS implantation from December 2017 to December 2019. Data abstracted include standard demographics, body mass index (BMI), pre- and postoperative apnea-hypopnea index (AHI), and Friedman tongue position (FTP). Additionally, change in hypopharyngeal cross-sectional area on awake tongue protrusion was abstracted. Patients protruded their tongues, and the physician visualized change. Positive change in hypopharyngeal cross-sectional area was documented as +1 and a negative change as -1. Chi-square tests for independence and logistic regression analysis were performed to determine indicators of successful surgery. Thirty-nine patients were included in this study. Mean ± SD AHI decreased significantly from 43.1 ± 17.36 to 9.18 ± 8.18. Surgical success was achieved in 79.5% of patients. Variables analyzed included BMI >32, preoperative AHI, FTP, and change in hypopharyngeal cross-sectional area on awake tongue protrusion (positive, 65.8%; negative, 34.2%). Positive predictors of success were positive change in hypopharyngeal cross-sectional area (P = .0133), severe OSA (P = .0290), and FTP IIb (P < .0001). Negative predictors were BMI >32 (P = .041) and negative change in hypopharyngeal cross-sectional area (P = .02). Positive change in hypopharyngeal cross-sectional area on awake tongue protrusion and severe baseline AHI were positive predictors of successful HGNS therapy. Negative change in hypopharyngeal cross-sectional area on awake tongue protrusion and BMI >32 were negative predictors.

The changes in oral volume and hyoid bone position after maxillomandibular advancement and genioglossus advancement for patients with obstructive sleep apnea.

Maxillomandibular advancement (MMA) and genioglossus advancement (GA) are surgeries for patients with obstructive sleep apnea(OSA). Postoperative evaluation is primarily based on the apnea-hypopnea index (AHI) measured by polysomnography. The purpose of this study was to identify the timing of hyoid bone relocation after MMA and GA surgery and to investigate whether or nothyoid bone relocation can be an indicator of postoperative evaluation of OSA. Patients with OSAunderwent MMA and GA surgery. Changes in hyoid bone position and tongue-to-oral volume ratio were analyzed on lateral radiographs before, immediately after, and 1year after surgery. Then, a correlation was verified between these changes and postoperative AHI. In18 patients studied, the position of the hyoid bone did not show a constant tendency immediately after surgery. One year after surgery, the bone had moved anteriorly and toward the oral cavity in all patients compared to its preoperative position. And AHI correlated with the movement of the hyoid bone to the oral side. One year after surgery, the tongue was adapted to the newly enlarged oral space, and as a result, the low position of the hyoid bone before the operation was improved. The findings suggest that the degree of loweringof the hyoid bone may be an indicator of the improvement of AHI.