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. 2022 Oct;27(10):890-899.
doi: 10.1111/resp.14280. Epub 2022 May 21.

Examining the impact of multilevel upper airway surgery on the obstructive sleep apnoea endotypes and their utility in predicting surgical outcomes

Ai-Ming Wong  1   2 , Shane A Landry  3   4 , Simon A Joosten  1   2 , Luke D J Thomson  3   4 , Anthony Turton  1 , Jeremy Stonehouse  1 , Darren R Mansfield  1   4 , Glen Burgess  5   6 , Andrew Hays  5 , Scott A Sands  7   8 , Christopher Andara  3 , Caroline J Beatty  3   4 , Garun S Hamilton  1   2 , Bradley A Edwards  3   4
Affiliations

Examining the impact of multilevel upper airway surgery on the obstructive sleep apnoea endotypes and their utility in predicting surgical outcomes

Ai-Ming Wong et al. Respirology. 2022 Oct.

Abstract

Background and objective: Upper airway surgery for obstructive sleep apnoea (OSA) is an alternative treatment for patients who are intolerant of continuous positive airway pressure (CPAP). However, upper airway surgery has variable treatment efficacy with no reliable predictors of response. While we now know that there are several endotypes contributing to OSA (i.e., upper airway collapsibility, airway muscle response/compensation, respiratory arousal threshold and loop gain), no study to date has examined: (i) how upper airway surgery affects all four OSA endotypes, (ii) whether knowledge of baseline OSA endotypes predicts response to surgery and (iii) whether there are any differences when OSA endotypes are measured using the CPAP dial-down or clinical polysomnographic (PSG) methods.

Methods: We prospectively studied 23 OSA patients before and ≥3 months after multilevel upper airway surgery. Participants underwent clinical and research PSG to measure OSA severity (apnoea-hypopnoea index [AHI]) and endotypes (measured in supine non-rapid eye movement [NREM]). Values are presented as mean ± SD or median (interquartile range).

Results: Surgery reduced the AHITotal (38.7 [23.4 to 79.2] vs. 22.0 [13.3 to 53.5] events/h; p = 0.009). There were no significant changes in OSA endotypes, however, large but variable improvements in collapsibility were observed (CPAP dial-down method: ∆1.9 ± 4.9 L/min, p = 0.09, n = 21; PSG method: ∆3.4 [-2.8 to 49.0]%Veupnoea , p = 0.06, n = 20). Improvement in collapsibility strongly correlated with improvement in AHI (%∆AHISupineNREM vs. ∆collapsibility: p < 0.005; R2 = 0.46-0.48). None of the baseline OSA endotypes predicted response to surgery.

Conclusion: Surgery unpredictably alters upper airway collapsibility but does not alter the non-anatomical endotypes. There are no baseline predictors of response to surgery.

Keywords: OSA endotypes; obstructive sleep apnoea; predictor; upper airway surgery; ventilation.

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Conflict of interest statement

Associate Professor Garun S. Hamilton and Dr Simon A. Joosten have received equipment to support research from ResMed, Phillips Respironics and Air Liquide Healthcare. Associate Professor Bradley A. Edwards was supported by a Heart Foundation Future Leader Fellowship (101167) and has received grant funding from Apnimed and personal fees from Signifier Medical outside the current work. Dr Joosten is supported by an NHMRC Early Career Fellowship (1139745). Dr Scott A. Sands has consulted for Apnimed, Nox Medical and Merck; has received grant support from Apnimed, Prosomnus and Dynaflex; and may receive royalties from intellectual property relating to medications for sleep apnoea licenced by his Institution to Apnimed; and his industry interactions are managed by Brigham and Women's Hospital. All other authors have no financial or non‐financial conflicts to disclose and do not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

Figures

FIGURE 1
FIGURE 1
Flow diagram of enrolment, exclusion criteria and final cohort included in the analysis. Initially, 28 participants were enrolled; however, only 23 had adequate data to be included in the final analysis. AHI, apnoea–hypopnoea index; NREM, non‐rapid eye movement; PSG, polysomnography
FIGURE 2
FIGURE 2
The effects of upper airway surgery on sleep and physiological variables. (A) Upper airway surgery significantly reduced the AHI; however, the effect was variable between individuals (Wilcoxon matched‐pairs signed‐rank test, p = 0.009). (B) There was a trend towards an improvement in upper airway collapsibility with upper airway surgery using either measurement (CPAP dial‐down [V passive_CPAP, L/min] or extracted from clinical PSG [V passive_PSG, %V eupnoea] methods); however, the effect was variable between individuals (paired t‐test, p = 0.09 and Wilcoxon test, p = 0.06 in (i) and (ii), respectively). Note, a higher value on either y‐axis indicates a less collapsible airway. AHI, apnoea–hypopnoea index; CPAP, continuous positive airway pressure; PSG, polysomnography; V passive, upper airway collapsibility
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References

    1. Sundaram S, Lim J, Lasserson TJ. Surgery for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews. 2005. 10.1002/14651858.cd001004.pub2 - DOI - PubMed
    1. Browaldh N, Nerfeldt P, Lysdahl M, Bring J, Friberg D. SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea. Thorax. 2013;68(9):846–53. - PubMed
    1. Stuck BA, Ravesloot MJL, Eschenhagen T, de Vet HCW, Sommer JU. Uvulopalatopharyngoplasty with or without tonsillectomy in the treatment of adult obstructive sleep apnea – a systematic review. Sleep Med. 2018;50:152–65. - PubMed
    1. MacKay S, Carney AS, Catcheside PG, Chai‐Coetzer CL, Chia M, Cistulli PA, et al. Effect of multilevel upper airway surgery vs medical management on the apnea‐hypopnea index and patient‐reported daytime sleepiness among patients with moderate or severe obstructive sleep apnea: the SAMS randomized clinical trial. JAMA. 2020;324(12):1168–79. - PMC - PubMed
    1. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188(8):996–1004. - PMC - PubMed

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