AHI Outcomes Are Superior after Upper Airway Reconstructive Surgery in Adult CPAP Failure Patients

• Published in: Otolaryngology-head and neck surgery 2016-03, Vol.154 (3), p.553-557
• Main Authors: Stewart, Samuel, Huang, June, Mohorikar, Alok, Jones, Andrew, Holmes, SueEllen, MacKay, Stuart G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Apnea‐Hypopnea Index; Continuous Positive Airway Pressure; continuous positive airways pressure; Female; Humans; Male; Middle Aged; obstructive sleep apnea; Oral Surgical Procedures - methods; Polysomnography; Prospective Studies; Reconstructive Surgical Procedures - methods; Sleep Apnea, Obstructive - surgery; Sleep Apnea, Obstructive - therapy; Treatment Failure; Treatment Outcome; upper airway reconstructive surgery
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599815621729

Objective This study aims to evaluate Apnea-Hypopnea Index (AHI) outcomes of upper airway adult obstructive sleep apnea (OSA) reconstructive surgery, as compared with outcomes of suboptimal continuous positive airway pressure (CPAP) therapy, in response to reviews claiming unreliable surgical AHI reduction. Study Design Prospective cohort study. Setting Single-surgeon series at medical centers within Wollongong, Australia. Subjects and Methods Adult patients with OSA who were partial device users or who refused CPAP were considered candidates for upper airway surgery (N = 48). Subjects underwent physical examination and polysomnography before and after surgery. Three groups were delineated on the nature of their suboptimal CPAP therapy: group 1, partially using CPAP or refusing long-term CPAP despite adherence (with available download data); group 2, unable or refusing to use CPAP with 2 sleep studies over time; group 3, unable or refusing to use CPAP with 1 sleep study over time. Collected data included demographics and AHI outcomes. Results Average AHI across all 3 groups with suboptimal CPAP therapy before surgery was 30.24 ± 17.17 events per hour sleep, as compared with the average postoperative AHI of 7.65 ± 6.59 events per hour sleep. This decrease was shown to be statistically significant with Wilcoxon signed-rank test (P < .0001). Conclusions AHI outcomes are superior with surgery in untreated or suboptimally treated adult OSA patients prescribed CPAP.