Multilevel upper airway surgery improves outcomes in adults with moderate to severe OSA
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Multilevel upper airway surgery reduced the number of apnea and hypopnea events and patient-reported sleepiness at 6 months compared with medical management in adults with moderate to severe obstructive sleep apnea.
“Surgical treatments aim to enlarge and stabilize the upper airway and may provide an option for patients in whom conventional medical treatment had failed,” Stuart MacKay, MD, professor at the University of Wollongong and surgeon at Illawarra Shoalhaven Local Health District and Illawarra ENT Head and Neck Clinic, Wollongong, Australia, and colleagues wrote. “However, to date, there have been few randomized trials evaluating the benefits and complications of these surgical procedures compared with controls and most have tested surgical treatment at a single level of the upper airway in highly select patients.”
Researchers conducted a multicenter, parallel-group, open-label, randomized clinical trial in 102 adults with symptomatic moderate or severe OSA (mean age, 44.6 years; 18% women) in whom conventional therapy failed. Patients were randomly assigned to multilevel surgery that included modified uvulopalatopharyngoplasty and minimally invasive tongue volume reduction (n = 51) or continued medical management that included advice on sleep positioning and weight loss (n = 51).
Primary outcomes were apnea-hypopnea index and Epworth Sleepiness Scale score following both interventions.
Baseline mean apnea-hypopnea index was 47.9 for the surgery group and 45.3 for the medical management group. At 6 months after intervention, the researchers reported greater improvement in mean apnea-hypopnea index from baseline in the surgery group compared with the medical management group (20.8 vs. 34.5; mean baseline-adjusted between-group difference, –17.6 events per hour of sleep; 95% CI, –26.8 to –8.4; P < .001).
Baseline mean Epworth Sleepiness Scale score was 12.4 for the surgery group and 11.1 for the medical management group. At 6 months after intervention, the researchers also reported greater improvement in mean Epworth Sleepiness Scale score from baseline in the surgery group compared with the medical management group (5.3 vs. 10.5; mean baseline-adjusted between-group difference, –6.7; 95% CI, –8.2 to –5.2; P <.001).
Researchers observed adverse events in two patients (4%) in the surgery group and none in the medical management group. One patient had a myocardial infarction and one patient was hospitalized following hematemesis of old blood.
“Further research is needed to confirm these findings in additional populations and to understand clinical utility, long-term efficacy and safety of multilevel upper airways surgery for treatment of patients with OSA,” the researchers wrote.