The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome

Michael Friedman, Rohit Soans, Ninos Joseph, Samir Kakodkar, Jacob Friedman
Laryngoscope 2009, 119 (1): 193-6

OBJECTIVE: To investigate the effect of multilevel upper airway surgery (USA) on subsequent continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS).

STUDY DESIGN: Fifty-two patients who underwent multilevel UAS with persistent symptoms of OSAHS represent the cohort for this study. All patients had undergone manual CPAP titrations both pre- and postoperatively. Patients were used as their own controls and were compared pre- and postoperatively with regard to body mass index, full night polysomnography (PSG), optimal CPAP pressure settings, presence of rapid eye-movement (REM) sleep, identification of mouth leakage, and CPAP compliance.

RESULTS: Postoperative values for apnea index (AI), apnea hypopnea index (AHI), and minimum oxygen saturation (min SaO(2)) were all significantly decreased from their preoperative levels. Compliance with CPAP therapy significantly increased from a mean 0.02 +/- 0.14 hours per night prior to surgery to a 3.2 +/- 2.6 hours per night following surgery (P < .001). In addition, the optimal CPAP pressure setting decreased significantly for a preoperative value of 10.6 +/- 2.1 cm H(2)O to 9.8 +/- 2.1 cm H(2)O following surgery. Fifty of the 52 patients (96.2%) studied were able to maintain optimal pressure settings without mouth leak, postoperatively.

CONCLUSIONS: In this study, most patients who had persistent symptoms of OSAHS after multilevel UAS did not have significant mouth leak that would preclude CPAP therapy. In this cohort of patients, CPAP pressure setting as well as compliance was significantly improved postoperatively.

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