This trial was registered at ClinicalTrials.gov as NCT00518128. There are no off-label or investigational uses of drugs and devices to disclose.
Article first published online: 18 JUN 2010
Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 120, Issue 7, pages 1481–1488, July 2010
How to Cite
Kezirian, E. J., Malhotra, A., Goldberg, A. N. and White, D. P. (2010), Changes in obstructive sleep apnea severity, biomarkers, and quality of life after multilevel surgery. The Laryngoscope, 120: 1481–1488. doi: 10.1002/lary.20946
The authors have the following relationships to disclose: Dr. Kezirian, Apnex Medical (medical advisory board, consultant), Medtronic (consultant), Pavad Medical (consultant); Dr. Malhotra, consulting and/or research grants from Apnex Medical, Cephalon, Ethicon, Itamar, NMT, Pfizer, Respironics, Restore/Medtronic, Sepracor; Dr. Goldberg, ApniCure (consultant, stockholder), Aspire Medical, Carbylan (consultant); and Dr. White, Itamar Medical (consultant), Pavad Medical (consultant), Philips Respironics (Chief Medical Officer).
- Issue published online: 25 JUN 2010
- Article first published online: 18 JUN 2010
- Manuscript Accepted: 25 FEB 2010
- This research was supported by Dr. Kezirian's career development award from the National Center for Research Resources (NCRR) of the National Institutes of Health (NIH)
- the Triological Society Research Career Development Award of the American Laryngological, Rhinological, and Otological Society, and a University of California San Francisco (UCSF) Research Evaluation and Allocation Committee research grant. Grant Numbers: NIH/NCRR/OD UCSF-CTSI, KL2 RR024130
- Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH
- The UCSF AIDS Specimen Bank was responsible for all processing, storing, and management of specimens for this study.
- Sleep apnea;
- C-reactive protein;
- quality of life;
- genioglossus advancement;
- Level of Evidence: 2b
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.
Prospective cohort study.
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.
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 ≥50% to an absolute level <15 events/hour), and body mass index ≤32 kg/m2 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.
This multilevel surgery was associated with a low likelihood of response in subjects with body mass index >32 kg/m2. Responders had decreased C-reactive protein levels that were independent of changes in body weight. Laryngoscope, 2010