What are the expected outcomes following surgical intervention for the treatment of obstructive sleep apnea (OSA)?

Updated: Feb 25, 2021
  • Author: Charles E Morgan, DMD, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
  • Print
Answer

Answer

Patients with mild obstructive disease are more likely to respond to surgical treatment than are those with more severe disease.

Most investigators define successful treatment of OSA as a decrease of 50% in the respiratory disturbance index (RDI) and a decrease in this number to less than 20 on postpolysomnography. Other, less objective measures include an improvement in the patient’s energy level and ability to concentrate.

The 59% surgical success rate of multilevel TCRFTA in a study by Steward was comparable with published success rates of 50% with UPPP and tongue-base TCRFTA and with published success rates of 42-59% with UPPP and midline glossectomy. [14] The published success rate with UPPP and genioglossus advancement is 35-77%, with or without hyoid myotomy and suspension. A study by de Ruiter et al found that maxillary-mandibular advancement had a 71% success rate in patients with moderate to severe OSA, with the mean apnea-hypopnea index reduced by 69%. Older age and larger neck circumference appeared to increase the risk of OSA treatment failure in this procedure. [15]

The published success rate of 90% or more with combined UPPP, genioglossus advancement, and maxillary-mandibular advancement is most impressive. [16, 17]

A study by MacKay et al indicated that in adults with moderate to severe OSA who have not responded to conventional therapy, treatment with combined palatal and tongue surgery is more effective than medical management at reducing apnea and hypopnea events and patient-reported sleepiness. Individuals in the study underwent either multilevel surgery (modified UPPP and minimally invasive tongue volume reduction) or ongoing medical management (aimed, for example, at sleep positioning and weight loss). Among the surgical patients, the apnea-hypopnea index fell from a mean 47.9 at baseline to 20.8 at 6 months, while the medical management patients saw the number drop from 45.3 at baseline to 34.5 at 6 months. Moreover, for the patients who underwent surgery, the mean Epworth Sleepiness Scale score changed from 12.4 at baseline to 5.3 at 6 months, while in the other patients the figures were 11.1 at baseline and 10.5 at 6 months. [18]

Patients at less than 125% of their ideal body weight are most likely to have short-term and long-term benefits from surgical treatment of snoring and obstructive sleep apnea (OSA). Other important variables include severity of disease, age at onset of symptoms, and comorbidities.

Outcome data from numerous studies have demonstrated significant short-term benefits from the aforementioned surgical procedures in appropriately selected patients. Additional efforts also affect the long-term results and prognosis for patients.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!