0613 Referral Patterns for Sleep Surgery in Patients with Obstructive Sleep Apnea

Introduction Surgical management of Obstructive Sleep Apnea (OSA) is utilized in patients unable to tolerate positive airway pressure (PAP). The American Academy of Sleep Medicine (AASM) recently published guidelines for referral for surgical consultation. The aim of this study was to characterize surgical referrals from an academic sleep medicine practice. Methods A retrospective chart review was conducted of 249 patients referred for sleep surgery from a sleep medicine practice from 01/01/2016 to 01/01/2023. All patients were initially evaluated by a sleep medicine provider at National Jewish Hospital. All patients considering sleep surgery were referred to the University of Colorado. A total of 142 patients (57.0%) completed at least one visit for surgical consultation. Demographics, polysomnographic parameters, details from evaluation in sleep surgery clinic and eventual surgical treatment were assessed. Pearson chi-square test, fisher exact test were utilized for ordinal variables. Analysis of variance and student t tests were utilized for continuous variables to determine statistically significant relationships with P< 0.05. Results Those completing a surgical visit were older at time of referral with mean (SD) age 59.0 (14.0) compared to 54.4 (14.5). Of patients referred for surgery, 24 (8.4%) had BMI>40, 43 (19.7%) had AHI< 15 and 27 (10.8%) had AHI>65. The majority, 107 of 142 (75.4%), of patients completing surgical evaluation did not undergo eventual surgery. Of the non-surgical cohort, 49 (45.8%) underwent a repeat trial of PAP, 22 (20.6%) had repeat sleep testing and 10 (9.3%) underwent trial of oral appliance therapy. Conclusion Sleep surgery is a viable alternative to management of OSA. In this study, a large proportion of patients originally referred for surgical evaluation did not complete follow up. Furthermore, the majority of patients seen in surgical clinic did not necessarily undergo surgery for OSA. Non-surgical modalities remained an option for patients with sleep surgery referral and likely enhanced decision-making by informing patients of risks and benefits of both surgical and non-surgical management. Further efforts should be made to understand reasons for incomplete follow-up or pursuit of non-surgical options to optimize surgical referrals for OSA. Support (if any)