title: Long-term quality-of-life outcomes following treatment for adult obstructive sleep apnoea: comparison of upper airway surgery, continuous positive airway pressure and mandibular advancement splints.
abstract: OBJECTIVE
  Long-term quality-of-life (QOL) outcomes, complications and clinical effectiveness in patients undergoing treatment with upper airway surgery (UAS), continuous positive airway pressure (CPAP) and mandibular advancement splints (MAS) for adult obstructive sleep apnoea (OSA).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Multidisciplinary OSA clinic in University teaching hospital.
  
  
  METHODS
  Consecutive, simultaneously treated patients with OSA undergoing UAS (n = 83), CPAP (n = 83) and MAS (n = 79).
  
  
  METHODS
  Glasgow Benefit Inventory (GBI), Snoring Severity Scale (SSS), Epworth Sleepiness Score (ESS) and side-effects in all three groups were recorded at a mean of 34.5 months following start of treatment and compared via anova with Bonferroni's adjustment for pairwise comparisons.
  
  
  RESULTS
  Upper airway surgery demonstrated a statistically significant QOL benefit over MAS. All three groups showed a significant improvement in SSS with CPAP significantly better than MAS, but equivalent to UAS. Uncomplicated UAS provided a greater QOL outcome than compliant MAS, non-compliant CPAP (P < 0.05) and comparable to compliant CPAP. Patients undergoing UAS with recorded complications still reported equivalent QOL outcomes to compliant CPAP and MAS, suggesting these surgical complications are relatively minor compared to the QOL benefit of OSA treatment.
  
  
  CONCLUSIONS
  Upper airway surgery showed a significant improvement in QOL outcomes compared to non-compliant CPAP or MAS and equivalent benefit to compliant CPAP. This study strongly supports the role for contemporary UAS in OSA when CPAP is not or no longer an option.
authors.affiliation: Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia.|Department of Surgery, Flinders University, Adelaide, SA, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Woods
authors.affiliation: Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Gunawardena
authors.affiliation: Memorial Hospital, Adelaide, SA, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Chia
authors.affiliation: Jetty Road Dental Clinic, Adelaide, SA, Australia.
authors.forename: N J
authors.initials: NJ
authors.lastname: Vowles
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Ullah
authors.affiliation: Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia.|Department of Surgery, Flinders University, Adelaide, SA, Australia.|Memorial Hospital, Adelaide, SA, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia.|Department of Surgery, Flinders University, Adelaide, SA, Australia.
authors.forename: A S
authors.initials: AS
authors.lastname: Carney
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D017286:Polysomnography; D011788:Quality of Life; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013165:Splints; D016896:Treatment Outcome