Changes in obstructive sleep apnea severity, biomarkers, and quality of life after multilevel surgery.
OBJECTIVE
To evaluate the impact of multilevel obstructive sleep apnea surgical treatment on sleep-disordered breathing severity, health-related measures, and quality of life, and to examine the association between changes in sleep-disordered breathing severity and these other outcomes.


METHODS
Prospective cohort study.


METHODS
Subjects with obstructive sleep apnea unable to tolerate positive airway pressure therapy and with evidence of multilevel (palate and hypopharynx) obstruction underwent uvulopalatopharyngoplasty, tonsillectomy, and genioglossus advancement, with or without hyoid suspension. All subjects had preoperative and postoperative study assessments, including blood draw for C-reactive protein, interleukin-6, homocysteine, homeostasis model of insulin resistance, and leptin, and evaluation with the Functional Outcomes of Sleep Questionnaire.


RESULTS
Thirty subjects underwent multilevel surgical treatment. The mean apnea-hypopnea index decreased from 44.9 +/- 28.1 to 27.8 +/- 26.4 events/hour (P = .008). Thirteen (43%) subjects in this heterogeneous sample achieved a response to surgery (defined as an apnea-hypopnea index reduction of >or=50% to an absolute level <15 events/hour), and body mass index <or=32 kg/m(2) was associated with a higher likelihood (55%, 12/22) of response (P = .04). There was no overall change in C-reactive protein levels, but responders demonstrated a decrease (-1.02 +/- 0.98 mg/L, P = .003) that was independent of changes in body weight. There were no significant changes in other health-related measures. Responders and nonresponders both demonstrated improvements in sleep-related quality of life.


CONCLUSIONS
This multilevel surgery was associated with a low likelihood of response in subjects with body mass index >32 kg/m(2). Responders had decreased C-reactive protein levels that were independent of changes in body weight.
Kezirian
Eric J
EJ
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA. ekezirian@ohns.ucsf.edu
Malhotra
Atul
A
Goldberg
Andrew N
AN
White
David P
DP
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D015850:Interleukin-6 / Q000097:blood; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000601:surgery*; D011795:Surveys and Questionnaires
D015415:Biomarkers; D015850:Interleukin-6; D020738:Leptin; D006710:Homocysteine; D002097:C-Reactive Protein