International expert consensus statement: surgical failure in obstructive sleep apnea

Giannicola Iannella¹, Annalisa Pace², Giuseppe Magliulo², Claudio Vicini³, Rodolfo Lugo⁴, Olivier M Vanderveken^{5

6

7}, Nico de Vries⁸, Kenny Pang⁹, Eric Thuler¹⁰, Ofer Jacobowitz¹¹, Michel Burihan Cahali¹², Joachim T Maurer¹³, Manuele Casale¹⁴, Antonio Moffa¹⁴, Fabrizio Salamanca¹⁵, Federico Leone¹⁵, Ewa Olszewska¹⁶, Carlos O'connor Reina¹⁷, Edilson Zancanella¹⁸, Paul T Hoff¹⁹, Peter Baptista²⁰, Ahmed Yassin Bahgat²¹, Madeline J L Ravesloot²², Peter van Maanen²³, Andrew Goldberg²⁴, Marina Carrasco²⁴, Vikas K Agrawal²⁵, Jerome R Lechien²⁶, Andrea De Vito²⁷, Giovanni Cammaroto²⁷, Armando De Virgilio², Antonio Greco², Patrizia Mancini², Tiziano Perrone²⁸, Steve Amado²⁹, Uri Alkan³⁰, Ryan Chin Taw Cheong³¹, Aurelio D'Ecclesia³², Dorina Galantai³³, Anand RajuAnand³⁴, Christian Calvo-Henriquez³⁵, Salvatore Cocuzza³⁶, Michele Arigliani³⁷, Alberto Maria Saibene³⁸, Rosario Marchese Aragona³⁹, Antonino Maniaci⁴⁰

Affiliations

¹ Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy. giannicola.iannella@uniroma1.it.
² Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy.
³ Department ENT & Audiology, University of Ferrara, Ferrara, Italy.
⁴ Department of Otorhinolaryngology, Grupo Medico San Pedro, 64660, Monterrey, Mexico.
⁵ Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium.
⁶ Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
⁷ Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.
⁸ Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
⁹ Asia Sleep Centre, Singapore, Singapore.
¹⁰ Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹¹ Sleep Department, ENT and Allergy Associates, New York, NY, USA.
¹² Departamento de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.
¹³ Division of Sleep Medicine, Department of Otorhinolaryngology, University Hospital Mannheim, Mannheim, Germany.
¹⁴ Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy.
¹⁵ Otorhinolaryngology Unit, San Pio X Hospital, 20159, Milan, Italy.
¹⁶ Department of Otolaryngology, Sleep Apnea Surgery Center, Medical University of Bialystok, 15-276, Bialystok, Poland.
¹⁷ Otorhinolaryngology Department, Hospital Quironsalud Marbella, Marbella, Spain.
¹⁸ State University of Campinas, Campinas, São Paulo, Brazil.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
²⁰ Otorhinolaryngology Department, Clínica Universitaria de Navarra, Pamplona, Spain.
²¹ Department of Otorhinolaryngology-Head & Neck Surgery, Alexandria University, Alexandria, 5424041, Egypt.
²² Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.
²³ Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, University of California, 2233 Post Street, Room 309, San Francisco, CA, 94115-1225, USA.
²⁴ Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain.
²⁵ Speciality ENT Hospital, Thakur Complex, Kandivali (E), Mumbai, Maharashtra, 400101, India.
²⁶ Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
²⁷ Department of Otolaryngology-Head and Neck Surgery, Forli Hospital, Forli, Italy.
²⁸ Otorhinolaryngology Unit, Civil Hospital of Alghero, Alghero, Italy.
²⁹ Maple Respiratory, Universidad del Rosario, Bogotá, Colombia.
³⁰ Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
³¹ Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK.
³² IRCCS 'Casa Sollievo Della Sofferenza', San Giovanni Rotondo, Italy.
³³ Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary.
³⁴ Department of ENT Surgery, PSG Hospitals, Coimbatore, India.
³⁵ Rhinology and Sleep Apnea Unit, Otolaryngology Department, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
³⁶ Deparment of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95123, Catania, Italy.
³⁷ Otolaryngology Unit, Vito Fazzi Hospital, Lecce, Italy.
³⁸ Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy.
³⁹ Otolaryngology Clinic, Department of Neurosciences, University of Padova, Padua, Italy.
⁴⁰ Department of Otolaryngology, Enna Kore University, Enna, Italy.

PMID: 39307877
PMCID: PMC11567991
DOI: 10.1007/s11325-024-03162-6

International expert consensus statement: surgical failure in obstructive sleep apnea

Giannicola Iannella et al. Sleep Breath. 2024 Dec.

. 2024 Dec;28(6):2601-2616.

doi: 10.1007/s11325-024-03162-6. Epub 2024 Sep 23.

Authors

Affiliations

¹ Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy. giannicola.iannella@uniroma1.it.
² Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy.
³ Department ENT & Audiology, University of Ferrara, Ferrara, Italy.
⁴ Department of Otorhinolaryngology, Grupo Medico San Pedro, 64660, Monterrey, Mexico.
⁵ Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium.
⁶ Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
⁷ Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.
⁸ Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
⁹ Asia Sleep Centre, Singapore, Singapore.
¹⁰ Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹¹ Sleep Department, ENT and Allergy Associates, New York, NY, USA.
¹² Departamento de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.
¹³ Division of Sleep Medicine, Department of Otorhinolaryngology, University Hospital Mannheim, Mannheim, Germany.
¹⁴ Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy.
¹⁵ Otorhinolaryngology Unit, San Pio X Hospital, 20159, Milan, Italy.
¹⁶ Department of Otolaryngology, Sleep Apnea Surgery Center, Medical University of Bialystok, 15-276, Bialystok, Poland.
¹⁷ Otorhinolaryngology Department, Hospital Quironsalud Marbella, Marbella, Spain.
¹⁸ State University of Campinas, Campinas, São Paulo, Brazil.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
²⁰ Otorhinolaryngology Department, Clínica Universitaria de Navarra, Pamplona, Spain.
²¹ Department of Otorhinolaryngology-Head & Neck Surgery, Alexandria University, Alexandria, 5424041, Egypt.
²² Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.
²³ Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, University of California, 2233 Post Street, Room 309, San Francisco, CA, 94115-1225, USA.
²⁴ Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain.
²⁵ Speciality ENT Hospital, Thakur Complex, Kandivali (E), Mumbai, Maharashtra, 400101, India.
²⁶ Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
²⁷ Department of Otolaryngology-Head and Neck Surgery, Forli Hospital, Forli, Italy.
²⁸ Otorhinolaryngology Unit, Civil Hospital of Alghero, Alghero, Italy.
²⁹ Maple Respiratory, Universidad del Rosario, Bogotá, Colombia.
³⁰ Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
³¹ Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK.
³² IRCCS 'Casa Sollievo Della Sofferenza', San Giovanni Rotondo, Italy.
³³ Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary.
³⁴ Department of ENT Surgery, PSG Hospitals, Coimbatore, India.
³⁵ Rhinology and Sleep Apnea Unit, Otolaryngology Department, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
³⁶ Deparment of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95123, Catania, Italy.
³⁷ Otolaryngology Unit, Vito Fazzi Hospital, Lecce, Italy.
³⁸ Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy.
³⁹ Otolaryngology Clinic, Department of Neurosciences, University of Padova, Padua, Italy.
⁴⁰ Department of Otolaryngology, Enna Kore University, Enna, Italy.

PMID: 39307877
PMCID: PMC11567991
DOI: 10.1007/s11325-024-03162-6

Abstract

Purpose: Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment.

Methods: A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts.

Results: Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the 'Definition of Surgical Success/Failure after OSA Surgery'. Regarding the 'Predictive Factors of Surgical Failure in OSA Surgery', consensus was reached on 10 out of 13 statements. In the context of the 'Diagnostic Workup in OSA Surgery', consensus was achieved on 9 out of 13 statements. Lastly, in 'Treatment in Surgical Failure Cases', consensus was reached on 12 out of 24 statements.

Conclusion: The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.

Keywords: Clinical guidelines; Delphi method; Expert consensus; Obstructive sleep apnea; Sleep disorder management.

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Conflict of interest statement

Declarations Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study.My manuscript has no associated data. Conflict of interest All authors declare no conflicts of interest and no competing interests.

Figures

**Fig. 1**
PRISMA-style flowchart of the article selection process

See this image and copyright information in PMC

References

1. Iannella G, Magliulo G, Lo Iacono CAM et al (2022) Quality of life and excessive daytime sleepiness in adults with obstructive sleep apnea who are treated with multilevel surgery or adherent to continuous positive airway pressure. J Clin Med 11(9):2375 - PMC - PubMed
1. Ulualp SO, Kezirian EJ (2024) Advanced diagnostic techniques in obstructive sleep apnea. Otolaryngol Clin North Am S0030–6665(24):00033–00041. 10.1016/j.otc.2024.02.020
1. Malhotra A, White DP (2002) Obstructive sleep apnoea. Lancet 360(9328):237–245 - PubMed
1. Myers KA, Mrkobrada M, Simel DL (2013) Does this patient have obstructive sleep apnea? The rational clinical examination systematic review. JAMA 310(7):731–741 - PubMed
1. Wickwire EM, Albrecht JS (2024) Occult, undiagnosed obstructive sleep apnea is associated with increased health care resource utilization and costs among older adults with comorbid depression: a retrospective cohort study among Medicare beneficiaries. J Clin Sleep Med. 10.5664/jcsm.10956 - PMC - PubMed

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International expert consensus statement: surgical failure in obstructive sleep apnea

Affiliations

International expert consensus statement: surgical failure in obstructive sleep apnea

Authors

Affiliations

Abstract

Conflict of interest statement

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Full Text Sources