Statistical model for postoperative apnea–hypopnea index after multilevel surgery for sleep-disordered breathing

Abstract

The objective of the study was to formulate a statistical model for postoperative apnea-hypopnea index (AHI) 3 and 12 months after multilevel surgery using the predictors preoperative AHI, body mass index (BMI) and age. The study design was a prospective cohort study. Data of 144 patients were collected prospectively 3 and 12 months after multilevel surgery for obstructive sleep apnea syndrome (OSAS) or upper airway resistance syndrome with excessive daytime sleepiness. The primary endpoint postoperative AHI and the secondary endpoint success according to the Sher criteria (postoperative AHI <20 h and >50% reduction of preoperative AHI) were modeled with multiple linear and logistic regression using the predictors preoperative AHI, BMI, age and the indicator whether the patient had undergone a tonsillectomy. Preoperative AHI and tonsillectomy had a highly significant positive influence on postoperative AHI after 3 months, whereas the influence of preoperative BMI was only marginally significant but numerically rather large. Age was not a significant decisive factor. The success according to the Sher criteria was highly significantly determined by the circumstance whether the patient had undergone a tonsillectomy, but not by the other predictors preoperative BMI or age. The responder rate with and without tonsillectomy was 58 and 19%, respectively. The odds ratio to be a responder if a tonsillectomy was conducted was 5.7. This study provides statistical models predicting postoperative AHI and success according to the Sher criteria after multilevel surgery for OSAS.

Contribution of Hyoid and Tonsillar Procedures to Outcome in Multilevel Surgery for Obstructive Sleep Apnea Syndrome

“…Group A of our patient population was significantly younger than the other groups. However, data from the literature show that age does not affect the outcome of surgery for OSA [2,5,11]. Patients in group B had significantly less nasal surgery than the other groups.…”

“…Moreover, tonsillectomy has been found to be a decisive factor [4,5]. Patients with accompanying tonsillectomy had a 6-fold higher chance of being a responder in multilevel surgery than patients who had already received tonsillectomy in previous surgery [5]. …”

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis

“…Tschopp et al performed a statistical model for multilevel surgery and found that 58% of patients who had a tonsillectomy as part of the multilevel surgery were responders, whereas only 19% of patients who had no tonsillectomy as part of the multilevel surgery were responders . Given the findings in previous studies, tonsillectomy alone could potentially play an important role in improving adult OSA.…”

A study on evaluation of pre and postoperative polysomnography for obstructive sleep apnea patients

“…4 Multilevel surgery provides a valuable alternative to CPAP therapy especially if conducted in combination with tonsillectomy. When comparing studies on multilevel surgery, special attention should be paid to the rate of tonsillectomy in the patient population.…”

“…However, majority of the patients abandon CPAP therapy because of refusal or intolerance. 4 Though the OSA patients are classically treated with lifestyle modifications and medical management, compliance is poor in these patients and thus warranting surgical management. Surgical modification of airway has been performed since decades but with inconsistent results.…”