Effect of Revised UPPP Surgery on Ambulatory BP in Sleep Apnea Patients with Hypertension and Oropharyngeal Obstruction

Yu, Shudong; Liu, Fenye; Wang, Qirong; Han, Fei; Deng, Liangzhen; Liang, Hui; Cui, Zhaoyang

doi:10.3109/10641960902993079

Cited by 17 publications

(12 citation statements)

References 32 publications

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“…Although many patients with OSA worldwide have undergone upper airway surgery, studies of health improvements associated with such surgery are rare and have been conducted with small samples. De Paula Soares et al and Yu et al reported that blood pressure fell after surgery, and Li et al found that the improvements of certain lipids were associated with surgical treatments in OSA, which is in agreement with our data. In addition, these metabolic factors combine multiplicatively to increase the CVD risk .…”

Section: Discussionsupporting

confidence: 93%

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

Qian

Zou

et al. 2019

The Laryngoscope

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Objectives To evaluate the association between upper airway surgery and changes of cardiological metabolic biomarkers and the overall cardiovascular risk in obstructive sleep apnea (OSA), and to define factors associated with better cardiovascular outcomes. Methods A total of 161 patients with newly diagnosed OSA who underwent classical or modified uvulopalatopharyngoplasty with or without genioglossus advancement and hyoid suspension were included. The pre‐ and postoperative (at least 6 months later) assessments, including polysomnography, measurement of glucose and lipids, blood pressure, and overall cardiovascular risk (as estimated by Framingham Risk Scores), were compared. We accounted for multiple comparisons with the use of the Benjamini‐Hochberg correction. Results The mean follow‐up time was 2.5 ± 1.9 years. The apnea hypopnea index decreased significantly in the entire cohort (mean changes with 95% confidence intervals were [−25.3 (−29.5, −21.0) events/hour, P < 0.001]. We also noted decreases in the age‐adjusted Framingham Risk Scores [−2.5% (−4.0%, −1.0%), P < 0.001] as well as single cardiometabolic biomarkers, including glucose [−0.50 (−0.70, −0.30) mmol/L, P < 0.001], total cholesterol [−0.46 (−0.65, −0.28) mmol/L, P < 0.001], triglycerides [−0.56, (−0.99, −0.14) mmol/L, P = 0.014], low‐density lipoprotein cholesterol [−0.27, (−0.43, −0.11) mmol/L, P = 0.002], apolipoprotein B [−0.10 (−0.14, −0.07) g/L, P < 0.001], systolic blood pressure [−3.58 (−6.02, −1.14) mmHg, P = 0.007], and diastolic blood pressure [−3.25 (−5.47, −1.02) mmHg, P = 0.008] after surgery. Patients with preoperative metabolic abnormalities exhibited better postoperative risk profiles changes (P < 0.001). In addition, associations were found between Δapolipoprotein B, Δsystolic blood pressure, and improvements in nocturnal oxygen level after surgery. Conclusion OSA‐related upper airway surgery was associated with improvements in cardiological metabolic biomarker levels and the overall cardiovascular risk, especially in patients with both OSA and metabolic disorders. The changes in biomarker levels may be associated with improved oxygen saturation after surgery. Level of Evidence 4 Laryngoscope, 130:818–824, 2020

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Section: Discussionsupporting

confidence: 93%

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

Qian

Zou

et al. 2019

The Laryngoscope

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“…Changes in blood pressure following treatment for OSA were studied with the use of continuous positive airway pressure (CPAP) and intraoral appliances . Only one article in English on blood pressure variations in adults following surgical treatment could be found in the PubMed database …”

Section: Introductionmentioning

confidence: 99%

“…5 Only one article in English on blood pressure variations in adults following surgical treatment could be found in the PubMed database. 6 A new technique for pharyngeal surgery was proposed in 2003: lateral pharyngoplasty. 7 By proposing the myotomy of the superior pharyngeal constrictor muscle and the palatopharyngeal muscle to remove the passive constriction of the pharynx and support the lateral pharyngeal wall, this technique resulted in improved clinical and polysomnographic results compared to the classic and widespread uvulopalatopharyngoplasty (UPPP).…”

Section: Introductionmentioning

confidence: 99%

Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea

2013

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“…The most common procedure is the revised uvulopalatopharyngoplasty, for which a small study showed improvement in nighttime but not daytime blood pressure [61]. Oral appliances to maintain airway patency have also been used with some success [62].…”

Section: Diagnosis Of Sleep Apnea and Management Of Resistant Hypertementioning

confidence: 99%

Resistant Hypertension and Sleep Apnea: Pathophysiologic Insights and Strategic Management

et al. 2010

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Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea. The pathophysiology of sleep apnea-associated hypertension is characterized by sustained adrenergic activation and volume retention often posing treatment challenges in patients with resistant hypertension. This review will address some of the epidemiologic data associating apnea with the pathogenesis of resistant hypertension. Diagnosis and management of apnea and its associated hypertension will also be considered.

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Effect of Revised UPPP Surgery on Ambulatory BP in Sleep Apnea Patients with Hypertension and Oropharyngeal Obstruction

Cited by 17 publications

References 32 publications

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea

Resistant Hypertension and Sleep Apnea: Pathophysiologic Insights and Strategic Management

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