Changes in Obstructive Sleep Apnea Severity, Biomarkers, and Quality of Life After Multilevel Surgery

Overview

Journal Laryngoscope

Specialty Otorhinolaryngology

Date 2010 Jun 22

PMID 20564750

Citations 12

Authors

Eric J Kezirian

Atul Malhotra

Andrew N Goldberg

David P White

Affiliations

Soon will be listed here.

Abstract

Objectives/hypothesis: To evaluate the impact of multilevel obstructive sleep apnea surgical treatment on sleep-disordered breathing severity, health-related measures, and quality of life, and to examine the association between changes in sleep-disordered breathing severity and these other outcomes.

Study Design: Prospective cohort study.

Methods: Subjects with obstructive sleep apnea unable to tolerate positive airway pressure therapy and with evidence of multilevel (palate and hypopharynx) obstruction underwent uvulopalatopharyngoplasty, tonsillectomy, and genioglossus advancement, with or without hyoid suspension. All subjects had preoperative and postoperative study assessments, including blood draw for C-reactive protein, interleukin-6, homocysteine, homeostasis model of insulin resistance, and leptin, and evaluation with the Functional Outcomes of Sleep Questionnaire.

Results: Thirty subjects underwent multilevel surgical treatment. The mean apnea-hypopnea index decreased from 44.9 +/- 28.1 to 27.8 +/- 26.4 events/hour (P = .008). Thirteen (43%) subjects in this heterogeneous sample achieved a response to surgery (defined as an apnea-hypopnea index reduction of >or=50% to an absolute level <15 events/hour), and body mass index <or=32 kg/m(2) was associated with a higher likelihood (55%, 12/22) of response (P = .04). There was no overall change in C-reactive protein levels, but responders demonstrated a decrease (-1.02 +/- 0.98 mg/L, P = .003) that was independent of changes in body weight. There were no significant changes in other health-related measures. Responders and nonresponders both demonstrated improvements in sleep-related quality of life.

Conclusions: This multilevel surgery was associated with a low likelihood of response in subjects with body mass index >32 kg/m(2). Responders had decreased C-reactive protein levels that were independent of changes in body weight.

Citing Articles

International Consensus Statement on Obstructive Sleep Apnea.

Chang J, Goldberg A, Alt J, Mohammed A, Ashbrook L, Auckley D Int Forum Allergy Rhinol. 2022; 13(7):1061-1482.

PMID: 36068685 PMC: 10359192. DOI: 10.1002/alr.23079.

Effects of oral appliances on serum cytokines in adults with obstructive sleep apnea: a systematic review.

Mecenas P, Miranda G, Fagundes N, Normando D, Ribeiro K Sleep Breath. 2021; 26(3):1447-1458.

PMID: 34482502 DOI: 10.1007/s11325-021-02485-y.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

Kent D, Stanley J, Aurora R, Levine C, Gottlieb D, Spann M J Clin Sleep Med. 2021; 17(12):2507-2531.

PMID: 34351849 PMC: 8726364. DOI: 10.5664/jcsm.9594.

Positive Airway Pressure Therapy Adherence with Mask Resupply: A Propensity-Matched Analysis.

Benjafield A, Oldstone L, Willes L, Kelly C, Nunez C, Malhotra A J Clin Med. 2021; 10(4).

PMID: 33673066 PMC: 7917762. DOI: 10.3390/jcm10040720.

Electrical stimulation of the whole hypoglossal nerve in patients with obstructive sleep apnea.

Oliven A, Dotan Y, Golibroda T, Somri M, Oliven R, Schwartz A Sleep Breath. 2020; 24(4):1473-1480.

PMID: 31907824 PMC: 9508899. DOI: 10.1007/s11325-019-02011-1.

References

Akashiba T, Akahoshi T, Kawahara S, Majima T, Horie T . Effects of long-term nasal continuous positive airway pressure on C-reactive protein in patients with obstructive sleep apnea syndrome. Intern Med. 2005; 44(8):899-900. DOI: 10.2169/internalmedicine.44.899. View

Steward D, Huntley T, Woodson B, Surdulescu V . Palate implants for obstructive sleep apnea: multi-institution, randomized, placebo-controlled study. Otolaryngol Head Neck Surg. 2008; 139(4):506-10. DOI: 10.1016/j.otohns.2008.07.021. View

Guilleminault C, Kirisoglu C, Ohayon M . C-reactive protein and sleep-disordered breathing. Sleep. 2005; 27(8):1507-11. DOI: 10.1093/sleep/27.8.1507. View

Woodson B, Steward D, Weaver E, Javaheri S . A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2003; 128(6):848-61. DOI: 10.1016/S0194-59980300461-3. View

Lye K, Waite P, Meara D, Wang D . Quality of life evaluation of maxillomandibular advancement surgery for treatment of obstructive sleep apnea. J Oral Maxillofac Surg. 2008; 66(5):968-72. DOI: 10.1016/j.joms.2007.11.031. View

. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999; 22(5):667-89. View

Taheri S, Austin D, Lin L, Nieto F, Young T, Mignot E . Correlates of serum C-reactive protein (CRP)--no association with sleep duration or sleep disordered breathing. Sleep. 2007; 30(8):991-6. PMC: 1978379. DOI: 10.1093/sleep/30.8.991. View

Riley R, Guilleminault C, Powell N, Derman S . Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea: a case report. Sleep. 1984; 7(1):79-82. DOI: 10.1093/sleep/7.1.79. View

Friedman M, Ibrahim H, Bass L . Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002; 127(1):13-21. DOI: 10.1067/mhn.2002.126477. View

10.

Lachin J, Genuth S, Cleary P, Davis M, Nathan D . Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med. 2000; 342(6):381-9. PMC: 2630213. DOI: 10.1056/NEJM200002103420603. View

11.

Punjabi N, Beamer B . C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep. 2007; 30(1):29-34. PMC: 1978354. DOI: 10.1093/sleep/30.1.29. View

12.

Kezirian E, Goldberg A . Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review. Arch Otolaryngol Head Neck Surg. 2006; 132(2):206-13. DOI: 10.1001/archotol.132.2.206. View

13.

Kezirian E, White D, Malhotra A, Ma W, McCulloch C, Goldberg A . Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg. 2010; 136(4):393-7. DOI: 10.1001/archoto.2010.26. View

14.

Ridker P . Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003; 107(3):363-9. DOI: 10.1161/01.cir.0000053730.47739.3c. View

15.

Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G . Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003; 107(8):1129-34. DOI: 10.1161/01.cir.0000052627.99976.18. View

16.

Friedman M, Bliznikas D, Vidyasagar R, Woodson B, Joseph N . Reduction of C-reactive protein with surgical treatment of obstructive sleep apnea hypopnea syndrome. Otolaryngol Head Neck Surg. 2006; 135(6):900-5. DOI: 10.1016/j.otohns.2005.10.066. View

17.

Elshaug A, Moss J, Southcott A, Hiller J . Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep. 2007; 30(4):461-7. DOI: 10.1093/sleep/30.4.461. View

18.

Sher A, Schechtman K, Piccirillo J . The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996; 19(2):156-77. DOI: 10.1093/sleep/19.2.156. View

19.

Rodriguez-Bruno K, Goldberg A, McCulloch C, Kezirian E . Test-retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg. 2009; 140(5):646-51. PMC: 2845469. DOI: 10.1016/j.otohns.2009.01.012. View

20.

Sanner B, Kollhosser P, Buechner N, Zidek W, Tepel M . Influence of treatment on leptin levels in patients with obstructive sleep apnoea. Eur Respir J. 2004; 23(4):601-4. DOI: 10.1183/09031936.04.00067804. View