title: AHI Outcomes Are Superior after Upper Airway Reconstructive Surgery in Adult CPAP Failure Patients.
abstract: OBJECTIVE
  This study aims to evaluate Apnea-Hypopnea Index (AHI) outcomes of upper airway adult obstructive sleep apnea (OSA) reconstructive surgery, as compared with outcomes of suboptimal continuous positive airway pressure (CPAP) therapy, in response to reviews claiming unreliable surgical AHI reduction.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single-surgeon series at medical centers within Wollongong, Australia.
  
  
  METHODS
  Adult patients with OSA who were partial device users or who refused CPAP were considered candidates for upper airway surgery (N = 48). Subjects underwent physical examination and polysomnography before and after surgery. Three groups were delineated on the nature of their suboptimal CPAP therapy: group 1, partially using CPAP or refusing long-term CPAP despite adherence (with available download data); group 2, unable or refusing to use CPAP with 2 sleep studies over time; group 3, unable or refusing to use CPAP with 1 sleep study over time. Collected data included demographics and AHI outcomes.
  
  
  RESULTS
  Average AHI across all 3 groups with suboptimal CPAP therapy before surgery was 30.24 ± 17.17 events per hour sleep, as compared with the average postoperative AHI of 7.65 ± 6.59 events per hour sleep. This decrease was shown to be statistically significant with Wilcoxon signed-rank test (P < .0001).
  
  
  CONCLUSIONS
  AHI outcomes are superior with surgery in untreated or suboptimally treated adult OSA patients prescribed CPAP.
authors.affiliation: Department of Otolaryngology, The Wollongong Hospital, Wollongong, Australia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Department of Otolaryngology, The Wollongong Hospital, Wollongong, Australia.
authors.forename: June
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology, The Wollongong Hospital, Wollongong, Australia.
authors.forename: Alok
authors.initials: A
authors.lastname: Mohorikar
authors.affiliation: Department of Respiratory Medicine, The Wollongong Hospital, Wollongong, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jones
authors.affiliation: Illawarra ENT Head & Neck Clinic, Wollongong, Australia.
authors.forename: SueEllen
authors.initials: S
authors.lastname: Holmes
authors.affiliation: Department of Otolaryngology, The Wollongong Hospital, Wollongong, Australia Illawarra ENT Head & Neck Clinic, Wollongong, Australia Woolcock Institute of Medical Research, Sydney, Australia sgmackay@ozemail.com.au.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: MacKay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D017286:Polysomnography; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000601:surgery* / Q000628:therapy; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Apnea-Hypopnea Index; continuous positive airways pressure; obstructive sleep apnea; polysomnography; upper airway reconstructive surgery