The implication of sleep position in the evaluation of surgical outcomes in obstructive sleep apnea.
OBJECTIVE
To investigate the effect of sleep position on surgical outcomes in obstructive sleep apnea (OSA).


METHODS
Retrospective review of 69 consecutive patients.


METHODS
Preoperative and postoperative polysomnographic data and Epworth sleepiness scale were obtained. Patients were categorized into success, response, no response, and failure groups according to apnea-hypopnea index (AHI) after uvulopalatopharyngoplasty. Proportions of supine or lateral position and AHI of each position were evaluated. Position-corrected AHI was developed in order to eliminate the effect of sleep position.


RESULTS
Preoperative proportion of supine position in the failure group (n = 26) was 41.3 percent, which was the lowest among four groups (P = 0.010), and increased to 60.8 percent postoperatively (P = 0.028). Twenty-two (84.6%) among the failure group had supine position dependency. Regrouped by position-corrected AHI, 15 patients moved into different groups. Postoperative AHI showed positive correlation with increased supine position when BMI was controlled (r = 0.515, P = 0.006).


CONCLUSIONS
Without appropriate correction based on the change of sleep position, the fluctuation of sleep position in each polysomnography might confound surgical outcomes in OSA patients. Thus, it is a substantial issue how to control or reflect the positional effect on AHI when treatment results are evaluated.
Lee
Chul Hee
CH
Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-Gu, Seongnam, Korea.
Shin
Hyun-Woo
HW
Han
Doo Hee
DH
Mo
Ji-Hun
JH
Yoon
In-Young
IY
Chung
Seockhoon
S
Choi
Hyo Geun
HG
Kim
Jeong-Whun
JW