PURPOSE: Compliance with CPAP remains a problem for many patients with obstructive sleep apnea (OSA). In some cases, anatomic factors may influence CPAP tolerance. There is limited data on the role of adjunctive upper airway surgery in obese patients who require CPAP therapy. We hypothesized that upper airway surgery will improve CPAP compliance in obese OSA patients who are poorly compliant with CPAP.
METHODS: We performed a retrospective study of obese patients (body mass index (BMI) > 30 kg/m2) with OSA who underwent upper airway surgery at our institution between 2002 and 2005. The type of surgery was determined by the ENT specialist. Inclusion criteria: 1) documented OSA (apnea hypopnea index (AHI) > 5 by polysomnogram (PSG)) and on CPAP therapy 2) poor CPAP compliance (< 4 hours per night) 3) repeat PSG after surgery revealing persistent OSA (AHI > 5) requiring further CPAP therapy 4) availability of CPAP compliance data. Data regarding demographics, type of surgery, surgical complications, PSG parameters, CPAP/BiPAP titrations, and CPAP compliance pre- and post-surgery were collected. The primary outcome measure was CPAP compliance. Results were analyzed using SPSS.
RESULTS: 14 patients were available for analysis. Demographics: age 50 +/− 25.5 years old, 57% female. Type of surgery: 7% nasal only, 28% oral only, 65% combined nasal / oral. Complications: nasal dryness in 1 patient post-surgery. PSG parameters: mean AHI 65.5 pre- vs. 26.8 post-surgery (p<0.005), mean CPAP requirement 12.1 cm H2O pre- vs. 10.5 cm H20 post-surgery (p=0.02). There was no change in mean BMI pre- and post-surgery (42.6 vs. 41.7 kg/m2, p=0.5). CPAP compliance: 2.14 hours per night (h/n) pre- vs. 2.89 h/n post-surgery (p=0.04), an improvement of 45 minutes following surgery. Compliance improved to > 4 h/n in 4 patients (29%) and did not improve or worsened in 3 patients (21%).
CONCLUSION: Upper airway surgery in select obese patients with OSA may improve CPAP compliance.
CLINICAL IMPLICATIONS: In obese OSA patients with poor CPAP compliance, adjunctive airway surgery should be considered.
DISCLOSURE: Ranju Chandrashekariah, None.