Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea.

OBJECTIVES: To assess the impact of the American Academy of Sleep Medicine (AASM) 2012Rec criteria on the surgical success rate and polysomnography (PSG) parameters of patients with obstructive sleep apnea (OSA). STUDY DESIGN: A prospective clinical trial. METHODS: A total of 60 patients who performed surgery for treatment of OSA at the sleep breathing disorder center of a tertiary referral university hospital from October 1, 2015, to September 30, 2016, were enrolled. Preoperative and postoperative PSG were performed and scored using AASM 2007Rec and AASM 2012Rec . Surgical success was determined by criteria 1 (postoperative Apnea-Hypopnea Index [AHI] <20% and 50% reduction) and criteria 2 (postoperative AHI <10), and surgical success rates according to AASM 2007Rec and AASM 2012Rec were compared. RESULTS: PSG parameters including AHI, hypopnea index, respiratory effort-related arousals, respiratory disturbance index, and supine AHI scored significantly higher with AASM 2012Rec compared to AASM 2007Rec criteria, both preoperatively and postoperatively (all P < 0.05). Furthermore, when compared to the AASM 2007Rec criteria, AASM 2012Rec resulted in increased proportion of patients with severe OSA (70.0% vs. 95.0%; P < 0.001). For the surgical outcomes, AASM 2012Rec showed significantly lower surgical success rate both in criteria 1 (51.7% vs. 38.3%) and criteria 2 (35.0% vs. 18.3%) compared to the AASM 2007Rec , respectively (P < 0 .05). CONCLUSIONS: This study demonstrated that AASM 2012Rec tends to decrease the success rate of surgical outcome for OSA patients, suggesting that defining success of surgical treatment for OSA could be changed dramatically according to the hypopnea scoring criteria. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:825-831, 2020.

Is epiglottis surgery necessary for obstructive sleep apnea patients with epiglottis obstruction?

OBJECTIVES/HYPOTHESIS: To examine the effect of epiglottis obstruction during drug-induced sleep endoscopy (DISE) on the surgical results of multilevel sleep surgery without epiglottic intervention. STUDY DESIGN: Cross-sectional study. METHODS: This investigation involved patients diagnosed with severe obstructive sleep apnea (OSA) based on preoperative polysomnography (PSG), who underwent DISE followed by multilevel OSA surgery without epiglottic intervention at Kyung Hee Medical Center (Seoul, South Korea) between March 2013 and July 2016. During DISE, obstruction patterns of the upper airway were evaluated using the velum, oropharynx, tongue base, epiglottis classification method. Follow-up PSG was performed 3 months after surgery to determine the success rate of multilevel surgery without epiglottic intervention. A comparison was done between the group with epiglottis obstruction and the group without epiglottis obstruction. RESULTS: Epiglottis obstruction was observed during DISE in 43.7% of patients. After application of exclusion criteria, 54 subjects were included (27 with and 27 without epiglottis obstruction). DISE revealed an association between epiglottis obstruction and tongue base collapse (P = .02). Comparing pre- and postoperative PSG findings, both groups exhibited improvement postoperatively. The success rate was 44.4% in the epiglottis obstruction group and 40.7% in the non-epiglottis obstruction group (P = .80). There was no difference in surgical success rates between the two groups. CONCLUSIONS: The prevalence of epiglottis obstruction requiring epiglottic surgery was lower than what was found during DISE. Sleep surgeons may consider staged epiglottic surgery in patients with epiglottis obstruction. LEVEL OF EVIDENCE: 3b Laryngoscope, 129:2658-2662, 2019.