Characteristics of Adults Undergoing Soft Tissue and Orthognathic Surgery for Obstructive Sleep Apnea

Abstract

Objective: To identify clinical and demographic characteristics of adults with obstructive sleep apnea (OSA) undergoing soft tissue and orthognathic sleep surgery, assess temporal trends in surgery type and proportion of women undergoing surgery, and provide clinical perspective before wide-spread implementation of hypoglossal nerve stimulation (HGNS).Methods: In a retrospective cohort study, adults diagnosed with OSA from 2009 to 2016 were identified in a large integrated healthcare system. Characteristics between cohort members who did and did not undergo sleep surgeries were compared. Multivariable logistic regression models examined associations of different characteristics with whether surgery was performed.Results: Of 172,216 adults with OSA, 2,262 (1.3%) underwent sleep surgery during 2009-2017. The most common sleep surgery was palate surgery (56.9%), which decreased proportionately over time. In multivariable analysis, older age and obesity were associated with lower odds of undergoing surgery. Those who underwent tonsillectomy and adenoidectomy were more likely to have larger tonsils and not require additional surgery, whereas tongue reduction recipients were more likely to have severe OSA and require multiple surgery types. The proportion of women undergoing surgery increased over time (p < 0.001 from trend test).Conclusion: Clinical and demographic characteristics associated with soft tissue and orthognathic sleep surgery were identified in a large adult cohort prior to widespread implementation of HGNS. An increase in sleep surgery among women and a decrease in palate surgery over time were observed. The findings provide clinical perspective on sleep surgery performed prior to implementation of HGNS and may inform future studies examining its associations with patient characteristics.

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

“…22,23 However, a retrospective cohort study from a US hospital indicated a reduced likelihood of surgery among younger adults. 24 Sex disparities were also evident, with a 2016 study highlighting a greater surgical inclination among women, 25 whereas studies from Germany reported that women had a higher likelihood of receiving MAD as the preferred choice of treatment 26 and were also more likely to undergo DISE for presurgery evaluation. 27 Some studies also reported racial and ethnic disparities but had varied associations based on the type of study.…”

“…Two large national database studies from the United States reported a lower likelihood of surgery among Black and Hispanic individuals, 25,28 whereas another single institutional study from the United States observed a higher number of Hispanic patients undergoing surgical treatment for OSA. 24 Some of the studies also reported the impact of comorbidities and symptom severity in treatment type as such, patients with fewer comorbidities had a higher chance of receiving PAPalternative treatments. 22,29 Moreover, reduced rates of surgical treatments were reported among patients with Charlson Comorbidity Score >1 or other conditions that elevated anesthesia risks.…”

“…22,29 Moreover, reduced rates of surgical treatments were reported among patients with Charlson Comorbidity Score >1 or other conditions that elevated anesthesia risks. 24,28 A general lack of awareness regarding alternative OSA treatment options, 30 importance of improving daytime sleepiness 26 as well as partners witnessing nighttime snoring and apnea 31 were also reported as factors influencing individual decision to receive PAP-alternative treatments. Additionally, studies reporting on income noted that OSA patients with higher income and occupational status were more likely to receive PAP-alternative treatments.…”