Targeted Multilevel Surgical Management of Obstructive Sleep Apnea: A Case Series of 44 Patients

Abstract

Objectives:

(1) Assess the effectiveness of multilevel surgery in the treatment of obstructive sleep apnea (OSA). (2) Analyze outcomes based on reduction of apnea hypopnea index (AHI) and positive airway treatment pressures.

Methods:

Case-series review in a tertiary referral center. A total of 44 patients underwent multilevel OSA surgery between November 2009 and September 2013. Depending on the preoperative examination and OSA severity based on sleep study, patients underwent multilevel surgery including nasal, oropharyngeal, transoral robotic, tongue base, hyoid, and/or orthognathic surgery. Follow-up sleep studies at 4 months were obtained and compared with preoperative data.

Results:

Overall AHI was significantly reduced from a mean of 44.5 to 19.9 (P = .0008), 78.9 to 35.8 (P = .0001) in the severe OSA group, 21.4 to 7.0 (P = .0001) in the moderate group, and 8.7 to 4.5 (P = .0004) in the mild group. AHI reduced from mean of 98.1 to 31.7 (P = .0013) in those who underwent orthognathic surgery and 36.1 to 18.1 (P = .011) in those who had soft tissue procedures without orthognathic surgery. Overall continuous positive airway pressure (CPAP) improved from mean of 10.9 to 4.7 cmH₂0 (P = .0001). Body mass index was significantly higher in the severe OSA group than the mild and moderate groups. No significant difference was noted in neck circumference between the 3 groups.

Conclusions:

Targeted multilevel OSA surgery in this cohort was successful in an overall reduction of AHI and CPAP pressures. The maximum improvement in AHI was seen in patients with moderate OSA and in those who had an orthognathic procedure.