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Evaluation of the success of obstructive sleep apnea surgery using criteria based on long-term symptoms and incident hypertension

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Abstract

Objective

To identify appropriate success criteria, based on long-term symptoms and incident hypertension, after surgery for obstructive sleep apnea (OSA).

Methods

This observational cohort study included 97 adult OSA patients (90 men) who underwent surgical treatment at our tertiary medical center. Subjective symptoms [witnessed sleep apnea and snoring, and Epworth sleepiness scale (ESS) scores] were evaluated through a telephone survey, and incident hypertension was assessed from medical records. The subjects were divided into success and failure groups according to seven different criteria, and data were analyzed to identify the criteria that could significantly differentiate the success from failure groups.

Results

The participants had a mean age of 48.8 ± 11.9 years and a mean preoperative body mass index of 26.5 ± 3.5 kg/m2. The mean preoperative and postoperative apnea–hypopnea index (AHI) values were 36.1/h and 19.4/h, respectively. The mean follow-up duration was 77.0 ± 31.1 months. Postoperative witnessed apnea, snoring, and the ESS scores decreased significantly compared to preoperative scores in both the success and failure groups based on most of the seven criteria. Among the seven criteria, success and failure groups based on a postoperative AHI cutoff of 15 or 20/h differed significantly in witnessed apnea, snoring, or ESS scores. Kaplan–Meier survival analysis based on incident hypertension revealed that no criterion could significantly distinguish between the two groups.

Conclusions

Our results suggest that some of the success criteria analyzed may be more useful in differentiating between success and failure groups after surgery, in terms of long-term improvement of subjective OSA-related symptoms.

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References

  1. Canessa N, Castronovo V, Cappa SF, Aloia MS, Marelli S, Falini A, Alemanno F, Ferini-Strambi L (2011) Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med 183:1419–1426

    Article  PubMed  Google Scholar 

  2. Partinen M, Guilleminault C (1990) Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest 97:27–32

    Article  CAS  PubMed  Google Scholar 

  3. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, Amodeo C, Bortolotto LA, Krieger EM, Bradley TD (2011) Obstr Sleep Apnea Hypertens 58:811–817

    Article  CAS  Google Scholar 

  4. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041

    Article  CAS  PubMed  Google Scholar 

  5. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239

    Article  PubMed  Google Scholar 

  6. Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:136–143

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rajagopalan N (2011) Obstructive sleep apnea: not just a sleep disorder. J Postgrad Med 57:168

    Article  CAS  PubMed  Google Scholar 

  8. Tuomilehto HP, Seppa JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T (2009) Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327

    Article  PubMed  Google Scholar 

  9. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2001) A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 163:1457–1461

    Article  CAS  PubMed  Google Scholar 

  10. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    Article  PubMed  Google Scholar 

  11. Tanyeri H, Polat S, Kirişoğlu CE, Serin GM (2012) Long-term efficacy of submucosal uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 269:2069–2074

    Article  PubMed  Google Scholar 

  12. Holty J-EC, Guilleminault C (2010) Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev 14:287–297

    Article  PubMed  Google Scholar 

  13. Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177

    Article  CAS  PubMed  Google Scholar 

  14. Elshaug A, Moss J, Southcott A (2007) Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep 30:461–467

    Article  PubMed  Google Scholar 

  15. Maurer JT (2009) Update on surgical treatment for sleep apnoea. Swiss Med Wkly 139:624

    PubMed  Google Scholar 

  16. Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, Skatrud J (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Me 157:1746–1752

    Article  CAS  Google Scholar 

  17. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31:1071–1078

    Article  PubMed  PubMed Central  Google Scholar 

  18. Marshall NS, Wong K, Cullen S, Knuiman MW, Grunstein RR (2014) Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med 10:355–362

    PubMed  PubMed Central  Google Scholar 

  19. Lee WH, Hong S-N, Kim HJ, Rhee C-S, Lee CH, Yoon I-Y, Kim J-W (2015) A comparison of different success definitions in non-continuous positive airway pressure treatment for obstructive sleep apnea using cardiopulmonary coupling. J Clin Sleep Med 12:35–41

    Article  Google Scholar 

  20. Marklund M, Stenlund H, Franklin KA (2004) Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 125:1270–1278

    Article  PubMed  Google Scholar 

  21. Yin SK, Liang Yi H, Ying Lu W, Guan J, Min Wu H, Cao ZY (2007) Genioglossus advancement and hyoid suspension plus uvulopalatopharyngoplasty for severe OSAHS. Otolaryngol Head Neck Surg 136:626–631

    Article  PubMed  Google Scholar 

  22. Wang L, Han W, Niu L, Qin Y, Liu J (2014) Nasal surgery and upper airway radiofrequency ablation in patients with obstructive sleep apnea hypopnea syndrome. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 28:154

    PubMed  Google Scholar 

  23. Bettega G, Pepin J-L, Veale D, Deschaux C, Raphael B, Levy P (2000) Obstructive sleep apnea syndrome: fifty-one consecutive patients treated by maxillofacial surgery. Am J Respir Crit Care Med 162:641–649

    Article  CAS  PubMed  Google Scholar 

  24. Lin HC, Friedman M, Chang HW, Gurpinar B (2008) The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope 118:902–908

    Article  PubMed  Google Scholar 

  25. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  CAS  PubMed  Google Scholar 

  26. Parker ED, Schmitz KH, Jacobs DR Jr, Dengel DR, Schreiner PJ (2007) Physical activity in young adults and incident hypertension over 15 years of follow-up: the CARDIA study. Am J Public Health 97:703–709

    Article  PubMed  PubMed Central  Google Scholar 

  27. Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 108:117–125

    Article  CAS  PubMed  Google Scholar 

  28. Toh S-T, Han H-J, Tay H-N, Kiong KL-Q (2014) Transoral robotic surgery for obstructive sleep apnea in Asian patients: a Singapore sleep centre experience. JAMA Otolaryngol Head Neck Surg 140:624–629

    Article  PubMed  Google Scholar 

  29. Yüksel A, Ugur KS, Kizilbulut G, Ark N, Kurtaran H, Kaya M, Gunduz M (2016) Long-term results of one staged multilevel surgery with tongue suspension surgery or one level palatal surgery for treatment of moderate and severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 273:1227–1234

    Article  PubMed  Google Scholar 

  30. Goh YH, Mark I, Fee WE (2007) Quality of life 17 to 20 years after uvulopalatopharyngoplasty. Laryngoscope 117:503–506

    Article  PubMed  Google Scholar 

  31. Woodson BT, Steward DL, Weaver EM, Javaheri S (2003) A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 128:848–861

    Article  PubMed  Google Scholar 

  32. Bausmer U, Gouveris H, Selivanova O, Goepel B, Mann W (2010) Correlation of the epworth sleepiness scale with respiratory sleep parameters in patients with sleep-related breathing disorders and upper airway pathology. Europ Eur Arch Otorhinolaryngol 267:1645–1648

    Article  Google Scholar 

  33. Walker-Engstrom M, Wilhelmsson B, Tegelberg A, Dimenas E, Ringqvist I (2000) Quality of life assessment of treatment with dental appliance or UPPP in patients with mild to moderate obstructive sleep apnoea. A prospective randomized 1-year follow-up study. J Sleep Res 9:303–308

    Article  CAS  PubMed  Google Scholar 

  34. Hayashida K, Inoue Y, Chiba S, Yagi T, Urashima M, Honda Y, Itoh H (2007) Factors influencing subjective sleepiness in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci 61:558–563

    Article  PubMed  Google Scholar 

  35. Olson L, Cole M, Ambrogetti A (1998) Correlations among Epworth Sleepiness Scale scores, multiple sleep latency tests and psychological symptoms. J Sleep Res 7:248–253

    Article  CAS  PubMed  Google Scholar 

  36. Johnson AG (1994) Surgery as a placebo. Lancet 344:1140–1142

    Article  CAS  PubMed  Google Scholar 

  37. Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth Sleepiness Scale. Chest 103:30–36

    Article  CAS  PubMed  Google Scholar 

  38. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, Nieto FJ, Rosenberg CE (1999) Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 159:502–507

    Article  CAS  PubMed  Google Scholar 

  39. Martin LM, Leff M, Calonge N, Garrett C, Nelson DE (2000) Validation of self-reported chronic conditions and health services in a managed care population. Am J Prev Med 18:215–218

    Article  CAS  PubMed  Google Scholar 

  40. Thawornchaisit P, De Looze F, Reid CM, Seubsman S-a, Sleigh A (2014) Validity of self-reported hypertension: findings from the Thai cohort study compared to physician telephone interview. Glob J Health Sci 6:1

    Google Scholar 

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Funding

This research was partly supported by the SNUBH Grant (02-2015-026) and the Bio and Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science and ICT (NRF-2015M3A9D7066972).

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, National Police Hospital, Seoul, South Korea

    Jae Hyun Lim

  2. Department of Otorhinolaryngology–Head and Neck Surgery, Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, Seoul, South Korea

    Pona Park

  3. Department of Otorhinolaryngology-Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, South Korea

    Jee Hye Wee

  4. Department of Otorhinolaryngology-Head and Neck Surgery, University of Santo Tomas Hospital, Manila, Philippines

    January E. Gelera

  5. Department of Otolaryngology and Head and Neck Surgery, Nepal Medical College Teaching Hospital, Jorpati, Nepal

    Kundan Kumar Shrestha

  6. Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Chae-Seo Rhee & Jeong-Whun Kim

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  1. Jae Hyun Lim
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Correspondence to Jeong-Whun Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Financial disclosure

The authors report no financial interests relevant to the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Since this was a retrospective study, no informed consent was obtained.

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Lim, J.H., Park, P., Wee, J.H. et al. Evaluation of the success of obstructive sleep apnea surgery using criteria based on long-term symptoms and incident hypertension. Eur Arch Otorhinolaryngol 275, 1015–1022 (2018). https://doi.org/10.1007/s00405-018-4894-7

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  • DOI: https://doi.org/10.1007/s00405-018-4894-7

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