Journal
SLEEP
Volume 40, Issue 7, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/sleep/zsx094
Keywords
obstructive sleep apnea; surgery; upper airway physiology; ventilatory control
Categories
Funding
- National Health and Medical Research Council of Australia [1064163]
- NHMRC Centre of Research Excellence, NeuroSleep
- NHMRC Early Career Fellowship
- R.G. Menzies award [1053201]
- American Heart Association [15SDG25890059]
- American Thoracic Society Foundation Unrestricted Grant
- National Health and Medical Research Council (NHMRC) of Australia's CJ Martin Overseas Biomedical Fellowship [1035115]
- Heart Foundation of Australia Future Leader Fellowship [101167]
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Study Objectives: Upper airway surgery is often recommended to treat patients with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airways pressure. However, the response to surgery is variable, potentially because it does not improve the nonanatomical factors (ie, loop gain [LG] and arousal threshold) causing OSA. Measuring these traits clinically might predict responses to surgery. Our primary objective was to test the value of LG and arousal threshold to predict surgical success defined as 50% reduction in apnea-hypopnea index (AHI) and AHI < 10 events/hour post surgery. Methods: We retrospectively analyzed data from patients who underwent upper airway surgery for OSA (n = 46). Clinical estimates of LG and arousal threshold were calculated from routine polysomnographic recordings presurgery and postsurgery (median of 124 [91-170] days follow-up). Results: Surgery reduced both the AHI (39.1 +/- 4.2 vs. 26.5 +/- 3.6 events/hour; p < .005) and estimated arousal threshold (-14.8 [-22.9 to -10.2] vs. -9.4 [-14.5 to -6.0] cm H2O) but did not alter LG (0.45 +/- 0.08 vs. 0.45 +/- 0.12; p = .278). Responders to surgery had a lower baseline LG (0.38 +/- 0.02 vs. 0.48 +/- 0.01, p < .05) and were younger (31.0 [27.3-42.5] vs. 43.0 [33.0-55.3] years, p < .05) than nonresponders. Lower LG remained a significant predictor of surgical success after controlling for covariates (logistic regression p = .018; receiver operating characteristic area under curve = 0.80). Conclusions: Our study provides proof-of-principle that upper airway surgery most effectively resolves OSA in patients with lower LG. Predicting the failure of surgical treatment, consequent to less stable ventilatory control (elevated LG), can be achieved in the clinic and may facilitate avoidance of surgical failures.
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