Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study.
OBJECTIVE
To assess separately the effectiveness and safety of nasal-continuous positive airway pressure (N-CPAP) and that of surgery in comparison to conservative management in patients with obstructive sleep apnea syndrome (OSAS). DESIGN. A randomized study with 1-year follow-up.


METHODS
A university hospital acting as a referral center for OSAS.


METHODS
Symptomatic patients with OSAS (72 male and 4 female patients aged 18 to 65 years), who had oxygen desaturations in the overnight recording.


METHODS
After the initial diagnostic workup, patients were considered to be candidates for either N-CPAP (44 patients) or surgical treatment (uvulopalatopharyngoplasty [UPPP] with or without mandibular osteotomy) (32 patients). Within the groups, the patients were then randomized to either the assigned treatment or conservative management.


METHODS
The number of nocturnal oxygen desaturation events of 4% or more per hour in bed (ODI4); daytime somnolence; side effects.


RESULTS
N-CPAP Group: Compliance with N-CPAP therapy at 1 year was 13 of 21. The most common reason for noncompliance was general intolerance of CPAP. All compliant patients had a normal ODI4 ( < 10), whereas 1 of 20 of their control subjects had a normal finding. Patients receiving active treatment were significantly less somnolent than their control subjects at 1 year (p < 0.05). SURGERY GROUP: At 1 year, 7 of 18 of the surgically treated and 1 of 14 of the conservatively treated patients had a normal ODI4 (p < 0.001). Daytime somnolence was significantly less severe in the surgically treated patients compared with their control subjects (p < 0.001) both at 3 and 12 months. The overall postoperative complication rate was 22%.


CONCLUSIONS
N-CPAP is an effective therapy for OSAS, but compliance is a problem. Surgical therapy (UPPP with or without mandibular osteotomy) needs further evaluation.
Lojander
J
J
Department of Pulmonary Medicine, University of Helsinki, Finland.
Maasilta
P
P
Partinen
M
M
Brander
P E
PE
Salmi
T
T
Lehtonen
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy; D010159:Palate / Q000601:surgery; D010349:Patient Compliance; D010614:Pharynx / Q000601:surgery; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011312:Pressure; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D014609:Uvula / Q000601:surgery; D014797:Vital Capacity