Surgery for Sleep Apnea Found to Equal CPAP Benefits

Reconstructive surgery of the upper airway for obstructive sleep apnea (OSA) holds the same quality-of-life (QOL) benefits as continuous positive airway pressure (CPAP), according to a new study.

Researchers from Memorial Hospital (Adelaide, Australia) conducted a consecutive cohort study of 166 adult patients with moderate-severe obstructive sleep apnea (OSA), of whom 77 underwent upper airway surgery, and 89 others were treated with CPAP therapy. Glasgow Benefit Inventory (GBI), change in snoring status and Epworth Sleepiness Scale (ESS), subjective CPAP compliance, and side effects in both groups were measured at mean 3.68 years (±0.48 years) after commencement of therapy.

The researchers found no significant difference between surgical outcomes for GBI, snoring, or ESS and CPAP controls. Among patients with moderate-to-severe OSA, those treated through upper airway surgery experienced the same level of long-term QOL improvement as their peers who were treated with CPAP therapy; among the QOL benefits were improvements in snoring, sleepiness, and neurocognitive impairment. In contrast, those patients who were prescribed, but did not adequately use CPAP, had minimal QOL improvement. CPAP side effects, reported in 26% of the patients, significantly reduced the QOL benefit of treatment, independent of compliance. Surgical complications (occurring in 44% of the patients) did not affect QOL treatment benefit. The study was published in the August 2009 issue of the journal Otolaryngology-Head and Neck Surgery.

"CPAP therapy is a highly effective means for treating obstructive sleep apnea, but because it involves a mask and set of hoses, it can be frustrating and uncomfortable for some patients, and compliance may be short-lived,” concluded lead author Sam Robinson, MB, BS, and colleagues. "Patients with poor CPAP compliance and/or significant side effects of CPAP therapy should be evaluated for contemporary upper airway reconstructive surgery.”

OSA is a common sleep apnea caused by obstruction of the airway, characterized by pauses in breathing during sleep. Breathing is interrupted by a physical block to airflow, despite the effort to breathe. In adults, the most typical individual with OSA syndrome suffers from obesity, with particular heaviness at the face and neck.

Related Links:
Memorial Hospital