The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome

Friedman, Michael; Soans, Rohit; Joseph, Ninos J.; Kakodkar, Samir

doi:10.1002/lary.20021

Cited by 35 publications

(39 citation statements)

References 10 publications

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“…As previously mentioned, 10 cm H 2 O was enough to effectively address many of the cases where oropharyngeal collapse was noted, but in this case a higher pressure was required to open up the airway. This case is important because it provides direct evidence of how surgery can serve as a tool to improve CPAP compliance by helping reduce CPAP pressure, which supports the evidence already presented by previous studies …”

Section: Discussionsupporting

confidence: 85%

Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

Torre

Liu

Kushida

et al. 2017

Clinical Otolaryngology

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The differential nCPAP effects observed in this study may help to understand some of the mechanisms responsible for inadequate patient response and poor nCPAP compliance. The use of DISE in combination with CPAP may serve as a first step in optimizing patients that failed to adapt to treatment with CPAP. This approach can help the physician identify patterns of airway collapse that may require varying pressures different from the one the patient is using, as well as anatomical factors that may be corrected to help with compliance.

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Section: Discussionsupporting

confidence: 85%

Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

Torre

Liu

Kushida

et al. 2017

Clinical Otolaryngology

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“…Eight studies were excluded due to lack of a comparison of pre- and postoperative CPAPs in patients after UAS. Of the 11 studies that met the inclusion criteria, 5 were retrospective [8,16,17,18,19], 4 were prospective [20,21,22,23], and 2 were RCTs [24,25]. UAS performed in the studies included nasal valve repair, radiofrequency ablation to the palate, turbinate reduction, septoplasty, Pillar implants, tonsillectomy, and UPPP.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis

Ayers

Lohia

Nguyen

et al. 2016

ORL

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Background /Aims: The aim of this study was to determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP). A secondary objective was to determine if a decrease in CPAP from UAS increases CPAP adherence. Methods: Studies were eligible for inclusion if a CPAP titration was performed both prior and following UAS in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after UAS were included to evaluate the secondary objective. Results: A total of 11 articles involving 323 patients were included in the review. The results show that there was a mean reduction in CPAP of 1.40 cm H₂O (95% CI -2.08 to -0.73). Four of the 11 papers, with a total of 80 patients, evaluated CPAP adherence and found a significant 0.62-hour improvement on average (95% CI 0.22-1.01). Conclusion: Due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea-hypopnea index and modestly reduces CPAP while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an adjunctive role in the management of OSA.

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“…Even though improved nasal breathing does not consistently improve OSAS itself, it can reduce daytime sleepiness and snoring [11-13]. Nasal obstruction usually causes mouth breathing during the day and night, which compromises adherence to CPAP therapy [14].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported that air leaks at a lower CPAP level and reduction in the maximal level of pressure can be tolerated in the patients with uvulopalatopharyngoplasty (UPPP) compared with those who have not [16,17]. On the contrary, more recent studies have reported an improvement in CPAP use after multilevel surgery for OSAS [11,18]. We found that patients with a history of upper airway surgery for OSAS or nasal obstruction use the CPAP machine significantly longer compared with those who have not undergone surgery.…”

Section: Discussionmentioning

confidence: 99%

Upper Airway Variation and Frequent Alcohol Consumption Can Affect Compliance With Continuous Positive Airway Pressure

Jeong

Kim

Hong

et al. 2016

Clin Exp Otorhinolaryngol

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ObjectivesCompliance with continuous positive airway pressure (CPAP) treatment remains a primary concern for improving treatment outcomes of obstructive sleep apnea. There are few studies that have considered the role of upper airway anatomy on the compliance with CPAP. We hypothesized that upper airway anatomy would influence the compliance with CPAP.MethodsOne hundred out of 161 consecutive patients were enrolled in this study. The following possible determinants were tested against CPAP use: demographic and anthropometric data, minimal cross-sectional area on acoustic rhinometry, cephalometric and polysomnographic data, questionnaires of Epworth sleepiness scale and Beck depression index, and histories of previous upper airway surgery, degree of nasal obstruction, daily cigarette consumption, and weekly frequency of alcohol intake.ResultsUnivariate analysis showed that histories of previous upper airway surgery and less frequent alcohol consumption, and longer mandibular plane-hyoid length (MP-H) on cephalometry were associated with longer average daily CPAP use. After adjustment for the confounding factors with multiple linear regression analysis, alcohol consumption and MP-H were still associated with the compliance with CPAP significantly.ConclusionTo improve compliance with CPAP, careful evaluations of upper airway problems and life style are important before initiating CPAP.

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The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome

Abstract: In this study, most patients who had persistent symptoms of OSAHS after multilevel UAS did not have significant mouth leak that would preclude CPAP therapy. In this cohort of patients, CPAP pressure setting as well as compliance was significantly improved postoperatively.

Cited by 35 publications

References 10 publications

Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis

Upper Airway Variation and Frequent Alcohol Consumption Can Affect Compliance With Continuous Positive Airway Pressure

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