Upper airway reconstructive surgery long-term quality-of-life outcomes compared with CPAP for adult obstructive sleep apnea.
OBJECTIVE
To measure long-term quality-of-life (QOL) improvement following contemporary multilevel upper airway reconstruction surgery, compared with continuous positive airway pressure (CPAP) therapy. Secondary aims were to investigate factors determining clinical effectiveness and QOL impact of reported side effects.


METHODS
Cohort study.


METHODS
Consecutive, simultaneously treated adult patients with moderate-severe obstructive sleep apnea (OSA) having upper airway surgery (N=77) or CPAP (N=89) therapy were studied by questionnaire. Glasgow Benefit Inventory (GBI), change in snoring status and Epworth Sleepiness Scale (ESS), subjective CPAP compliance, and side effects in both groups were measured at mean+/-SEM 44.12+/-5.78 months (3.68+/-0.48 years) after commencement of therapy.


RESULTS
No significant difference was seen between surgical outcomes for GBI, snoring, or ESS and CPAP controls. Multivariate analysis showed reduction in Respiratory Disturbance Index (RDI) predicted postoperative snoring and ESS, but not GBI outcomes. Snoring control and GBI were related to CPAP compliance (P<0.001). CPAP side effects (reported in 26%) significantly reduced the QOL benefit of treatment, independent of compliance. Surgical complications (occurring in 44%) did not affect QOL treatment benefit.


CONCLUSIONS
Patients with poor CPAP compliance and/or significant side effects of CPAP therapy (45% of cases in this series) should be evaluated for contemporary upper airway reconstructive surgery.
Robinson
Sam
S
Memorial Hospital, North Adelaide, South Australia, Australia. samjane@bigpond.net.au
Chia
Michael
M
Carney
A Simon
AS
Chawla
Sharad
S
Harris
Penelope
P
Esterman
Adrian
A
D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D017286:Polysomnography; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D020181:Sleep Apnea, Obstructive / Q000601:surgery* / Q000628:therapy; D012913:Snoring / Q000601:surgery* / Q000628:therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome