title: The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea.
abstract: We aimed to examine whether the duration of respiratory events and related oximetric values are associated with outcomes of multilevel upper airway surgery in patients with moderate-severe obstructive sleep apnea (OSA). The records of patients with a preoperative apnea-hypopnea index (AHI) >15 events/h, who underwent uvulopharyngopalatoplasty plus tongue base suspension with or without septoplasty between 2012 and 2014, were reviewed retrospectively. If the postoperative 6th month AHI was <20 events/h with at least a 50 % reduction from preoperative rates, the outcome of surgery was regarded as successful, otherwise, as failure. To calculate factors predictive of surgical outcomes, a receiver operating characteristic (ROC) analysis was performed. Logistic regression analyses were utilized to obtain the Odds ratio (OR) and 95 % confidential interval (CI). In total, 82 patients were enrolled in the study. Sixty-one patients (74.4 %) met the success criteria. The mean obstructive apnea duration (OAD) was the sole variable with a significant and satisfactory area under the curve (AUC) value [AUC (95 % CI) = 0.719 (0.597-0.842), p = 0.003]. The cutoff value was found to be 26.75 s with 71.4 % sensitivity, 72.1 % specificity, 88.0 % positive predictive value, and 46.9 % negative predictive value. Univariate analysis revealed an association between surgical failure and mean OAD > 26.75 s, total apnea duration, lowest SaO2, mean SaO2, mean O2 desaturation, and oxygen desaturation index, although only mean OAD > 26.75 s remained to be an independent predictor for unfavorable outcome after adjustment for other confounders in multivariate analysis [OR (95 % CI) = 3.92 (1.08-14.17), p = 0.041]. The current study suggests that OSA patients having longer OAD are in the risk of having surgical failure.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, Antalya, Turkey. draslibostanci@gmail.com.|Akdeniz University Hospital, Dumlupinar Bul, H-Blok, 07070, Konyaalti, Antalya, Turkey. draslibostanci@gmail.com.
authors.forename: Asli
authors.identifier: http://orcid.org/0000-0002-1535-2661
authors.initials: A
authors.lastname: Bostanci
authors.affiliation: Department of Biostatistics and Medical Informatics, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Selen
authors.initials: S
authors.lastname: Bozkurt
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Turhan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010092:Oximetry; D017286:Polysomnography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Apnea duration; OSA; Outcome; Surgery