A selection of journal article abstracts relevant to Sleep Surgery with links. Please do inform us if the links are no longer working.
S M Jara A I Phipps C Maynard E M Weaver - Sleep, Volume 41, Issue suppl_1, April 2018, Pages A210–A211, Published: 27 April 2018
Untreated obstructive sleep apnea (OSA) decreases long-term survival. OSA treatment, either continuous positive airway pressure (CPAP) or surgery, appears to improve survival. However, the duration of these survival benefits is unclear. We tested the association between OSA treatment and survival in a large, long-term cohort of veterans.
This retrospective cohort study included all adult veterans diagnosed with OSA in any Veterans Affairs (VA) inpatient facility 1993–2013 or outpatient facility 1997–2013. Subjects were identified by ICD-9 diagnosis codes in VA inpatient and outpatient files. OSA treatment (untreated versus prescribed CPAP versus surgery) was determined by ICD-9 or CPT procedure codes. Patients without a procedure code were considered untreated. Vital status as of 2/1/2017 was extracted from VA Vital Status Files. The Charlson Comorbidity Index was calculated from ICD-9 diagnosis codes from two years prior to OSA diagnosis. Survival was compared by OSA treatment (untreated versus prescribed CPAP versus surgery) using Kaplan-Meier estimates and mortality hazard with Cox regression, adjusting for age, sex, body mass index (BMI), comorbidity, and year of diagnosis.
The cohort included 638,029 untreated, 231,928 CPAP, and 6,977 surgery patients (N=876,934) with mean age 61+/-13 years, mostly male (96%), and some obese (48% BMI>30). The majority (76%) was diagnosed with OSA since 2010. Survival at 5 years was 76% for untreated, 84% for CPAP, and 83% for surgery (P<0.001 untreated versus treated [CPAP or surgery]), while survival at 20 years was 34% for untreated, 38% for CPAP, and 48% for surgery (P<0.001, untreated versus treated). The overall adjusted mortality hazard ratio for CPAP versus untreated was 0.79 (95%CI:0.78–0.80,P<0.001); for surgery versus untreated was 0.85 (95%CI:0.81–0.90,P<0.001); and for CPAP versus surgery was 0.93 (95%CI:0.88–0.97,P=0.004).
CPAP prescription and surgery each confer a survival advantage over no treatment for OSA. CPAP provides an overall survival advantage over surgery, but surgery appears to provide a long-term survival advantage over CPAP. These results suggest that OSA patients who do not use CPAP or stop using CPAP may benefit from surgery evaluation.
Rotenberg BW, Vicini C, Pang EB, Pang KP. - J Otolaryngol Head Neck Surg. 2016 Apr 6;45:23.
Continuous positive airway pressure (CPAP) is typically recommended as first line therapy for obstructive sleep apnea, but the adherence rate of CPAP is problematic. This study’s objective was to systematically review the literature relating to CPAP as first line therapy for OSA and compare it to surgical literature on the same topic.
A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. The primary search objective was to identify all papers reporting the results of (1) randomized clinical trials (RCT) of CPAP for the treatment of adults with OSA; and (2) both randomized and non-randomized clinical trials and case series on the surgical treatment of OSA in adults. A PhD-level biostatistician first screened papers, and then those that met study criteria were retrieved and analyzed using standardized forms for each author. The primary outcomes were adherence rates of CPAP.
A total of 82 controlled clinical trials for CPAP and 69 controlled and non-controlled surgery trials were identified for analysis. Variation in CPAP use within reported RCT trials were identified, and the majority of patients in the studies would eventually be considered non-adherent to CPAP.
When considering the numerous patient-related factors that come into play when CPAP is prescribed, the concept of CPAP as gold-standard therapy for OSA should be reconsidered. In many cases surgery can provide a better overall outcome. This study’s results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence.
Browaldh N, Bring J, Friberg D. Laryngoscope. 2016 Jun;126(6):1484-91.
Our previous study showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration in obstructive sleep apnea syndrome (OSAS) patients. This is a continuous study of changes in daytime sleepiness and quality of life.
Prospective randomized controlled trial (RCT), two parallel arms.
Sixty-five patients with apnea-hypopnea index≥15, body mass index<36, Epworth Sleepiness Scale (ESS)≥8, Friedman stage I or II, failing nonsurgical treatment. The intervention group (n = 32) underwent surgery, and the controls (n=33) had no treatment. At baseline and the 7-month follow-up, polysomnography, questionnaires, and vigilance tests were implemented.
All patients answered the questionnaires, and 48 took the vigilance test. Epworth Sleepiness Scale decreased significantly in the intervention group, from a mean (standard deviation) of 12.5(3.2) to 6.8(3.9), but nonsignificantly in the control group, from 12.9(3.1) to 12.5(3.9), a significant group difference (P < 0.001). The physical and mental component score on the Short Form-36 questionnaire increased significantly in the intervention group, from a mean 47.8(8.3) to 51.2(8.8) and from 42.1(10.6) to 48.1(9.7), respectively, but with nonsignificant changes in the controls: 49.0(9.0) to 48.3(9.1) and 41.0(10.2) to 42.7(11.5), significant group differences (P = 0.007, P = 0.031), respectively. The sleep latency/vigilance test showed a significant mean increase in the intervention group of 7(12.4) minutes and a decrease in the controls of 2.2(10.6), a significant group difference (P = 0.011). There were significant correlations between changes in subjective outcomes and nocturnal respiration.
This RCT shows that modified UPPP was effective in improving daytime sleepiness and quality of life in OSAS patients. It strengthens the body of evidence on the potential effect of surgery offered to selected patients.
1b. Laryngoscope, 126:1484-1491, 2016.