Surgery for obstructive sleep apnea: Sleep endoscopy determinants of outcome

OBJECTIVES/HYPOTHESIS: Although drug-induced sleep endoscopy is often employed to determine the site of obstruction in patients with obstructive sleep apnea (OSA) who will undergo upper airway surgery, it remains unknown whether its findings are associated with surgical outcome. This study tested the hypothesis that drug-induced sleep endoscopy variables can predict the outcome of upper airway surgery in OSA patients. STUDY DESIGN: Case series retrospective analysis. METHODS: Forty-nine OSA patients (41 male; mean apnea-hypopnea index AHI 30.9 ± 18.5 events/hour) underwent propofol-induced sleep endoscopy followed by upper airway surgery (palatal surgery, and/or radiofrequency ablation of the tongue base, and/or hyoid suspension) and subsequently a follow-up polysomnography to assess surgical outcome. RESULTS: Twenty-three patients (47%) were responders, and twenty-nine were nonresponders (53%). Nonresponders had a higher occurrence of complete or partial circumferential collapse at velum and complete antero-posterior collapse at tongue base or epiglottis in comparison with responders. Multivariate logistic regression analysis revealed that among baseline clinical and polysomnographic characteristics (e.g., AHI, body mass index) and sleep endoscopy findings, the presence of complete circumferential collapse at velum, and of complete antero-posterior collapse at tongue base were the only independent predictors of upper airway surgery failure. CONCLUSIONS: Drug-induced sleep endoscopy can be used to predict higher likelihood of response to upper airway surgery in OSA.