title: Morbidly obese patients with severe obstructive sleep apnea: is airway reconstructive surgery a viable treatment option?
abstract: OBJECTIVE
  To evaluate the outcomes of airway reconstructive surgery for the treatment of severe obstructive sleep apnea in the morbidly obese patient.
  
  
  METHODS
  Retrospective review of consecutively treated patients. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), cephalometric data, and complications.
  
  
  RESULTS
  Twenty-one patients (13 men) with a mean age of 42.6 +/- 7.9 years and mean BMI of 45 +/- 5.4 kg/m2 were identified. The mean RDI improved from 83 +/- 30.1 to 10.6 +/- 10.8 events per hour with an improved mean apnea index from 38.4 +/- 31.3 to 1.2 +/- 1.8 events per hour. The mean LSAT improved from 63.9 +/- 17.7% to 86 +/- 7.9%. The mean BMI at the 6-month postoperative polysomnographic recording was 43 +/- 4.3 kg/m2 (P < .001). Seventeen patients (81%) were successfully treated (RDI < 20 and with minimal desaturation < 90%). The mean follow-up was 21.8 +/- 15.4 months (range, 7-66 mo). Coexisting obesity-hypoventilation syndrome was related to treatment failure in two patients. One patient noted recurrence of daytime fatigue after significant weight gain 4 years after surgery and the polysomnographic recordings demonstrated the recurrence of obstructive sleep apnea.
  
  
  CONCLUSIONS
  Airway reconstruction is an effective treatment for severe obstructive sleep apnea in the morbidly obese patient. Careful patient selection and identifying potential coexisting obesity-hypoventilation syndrome, as well as counseling on weight reduction and avoiding continual weight gain will improve treatment outcomes. Key Words: Obstructive sleep apnea, sleep-disordered breathing, obstructive sleep apnea surgery, obesity, maxillomandibular advancement.
authors.affiliation: Stanford University Sleep Disorders and Research Center, California, USA. kaseyli@hotmail.com
authors.forename: K K
authors.initials: KK
authors.lastname: Li
authors.forename: N B
authors.initials: NB
authors.lastname: Powell
authors.forename: R W
authors.initials: RW
authors.lastname: Riley
authors.forename: A
authors.initials: A
authors.lastname: Zonato
authors.forename: L
authors.initials: L
authors.lastname: Gervacio
authors.forename: C
authors.initials: C
authors.lastname: Guilleminault
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis; D015992:Body Mass Index; D002508:Cephalometry; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D017286:Polysomnography; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome