Upper airway surgery has emerged as an effective treatment for obstructive sleep apnea (OSA). Drug induced sleep apnea (DISE) is a common procedure used to gauge a patient’s suitability for sleep surgery. However, DISE may pose an unnecessary burden on patients as its results are subjective and do not always align with a patient’s reported experience. In this study, we assessed preoperative characteristics of CPAP-intolerant patients to determine if such data can be used to predict a patient’s suitability for sleep surgery.
This was a retrospective cohort study of 192 patients treated for CPAP-intolerant OSA. Patient demographics, surgical history, DISE results, and polysomnogram results were collected from medical records and patients were stratified based on DISE values that correspond with worse surgical outcomes, such as a complete concentric collapse of the velum (CCV). Comparative statistics and logistic regression analyses were performed to compare patient characteristics based on DISE results and to determine if pre-DISE data could be used to predict DISE results. This study was reviewed and approved by the University of Michigan Institutional Review Board.
Patients with a CCV had higher preoperative BMIs (31.0 ± 5.3 vs 28.9 ± 3.8, p=0.02) and were less likely to have a history of prior sleep surgery (78.3% vs 50.6%, p=0.02). Preoperative polysomnogram data collected showed that patients with a CCV had a significantly higher hypopnea index than those without (39.8 ± 38.5 vs 23.1 ± 14.7, p=0.001). Finally, we found that for every unit increase in a patient’s hypopnea index, their odds of having a CCV increased by 4% (OR=1.04 [1.01-1.07], p=0.01).
Patients with a CCV differed significantly by race, BMI, past sleep surgical history, and preoperative hypopnea data. Additionally, a patient's preoperative hypopnea index was significantly related to their odds of having a complete concentric collapse of the velum. These preoperative characteristics may aid providers in decision-making prior to sleep surgery.