title: Redefining the timing of surgery for obstructive sleep apnea in anatomically favorable patients.
abstract: OBJECTIVE
  Healthcare remunerating agencies in North America require patients with obstructive sleep apnea (OSA) to undergo a continuous positive airway pressure (CPAP) trial before funding surgical therapy. The adherence rate of CPAP is problematic. This study's objective was to determine the proportion of surgically favorable patients who failed CPAP who subsequently benefitted from surgical therapy, and to explore consideration of surgical therapy as first-line treatment in this specific OSA subpopulation.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  Patients with moderate-severe OSA who had failed a minimum 6-month trial of CPAP were recruited. All had optimal anatomy for surgery and underwent tonsillectomy with palatoplasty ± septoplasty. Outcome measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Quality of Life Index (SAQLI-E), and blood pressure. Patients were followed for 1 year.
  
  
  RESULTS
  By AHI measurement, 85.7% of patients in the entire cohort were successfully treated by surgery. ESS while on CPAP was 13.7 ± 2.9, improving to 4.1 ± 2.5 after surgery. SAQLI-E scores on CPAP were 25.7 ± 5.8, improving to 10.2 ± 3.2 after surgery. Blood pressure remained elevated during CPAP but normalized after surgery. All changes were significant at P < .001.
  
  
  CONCLUSIONS
  Surgical intervention improved OSA severity as measured by the ESS, SAQLI-E, and blood pressure. These measures had not improved on CPAP. AHI improved as well. Our results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence and with only minor surgical risk.
  
  
  METHODS
  2 Laryngoscope 124:S1-S9, 2014.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
authors.forename: Jenna
authors.initials: J
authors.lastname: Theriault
authors.forename: Sophie
authors.initials: S
authors.lastname: Gottesman
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000601:surgery; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery* / Q000628:therapy*; D017211:Treatment Failure; D014609:Uvula / Q000601:surgery*
keywords: Obstructive sleep apnea; continuous positive airway pressure; tonsillectomy; uvulopalatoplasty