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

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 uvulopalatopharyngo-plasty, 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 >= 50% to an absolute level <15 events/hour), and body mass index <= 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.