Surgical Outcomes

Obstructive Sleep Apnea can be treated equally well by Surgery or CPAP. Since CPAP is considered the standard treatment, the findings of the sleep study after successful surgery should be as good as a sleep study while on CPAP. Indeed a successful surgical outcome will show relatively normalized sleep cycles, control of respiratory obstructions and a rise in oxygen levels, in fact equivalent to the results obtained by CPAP. Patients who complete a full course of surgical therapy can anticipate a greater than 95% chance of success and bypass the need for long-term CPAP therapy. Some of the medical research that supports the surgical approach to treating OSA is outlined below.

Powell & Riley (1993) reported on the surgical outcomes of more than three hundred patients treated by a surgical protocol. For those patients who followed through the protocol there was a 97% chance of surgical success. As determined by the site of airway obstruction, phase I therapy consisted of combinations of septoplasty, turbinate reduction, uvulo-palato-pharyngoplasty, tonsillectomy, genioglossus advancement or hyoid suspension. Phase 2 therapy consisted of maxillo-mandibular advancement and was reserved for patients that were unsuccessfully treated in the first stage of therapy. The results of phase I surgery showed that surgical success was inversely related to OSA severity; mild disease (RDI<20, LSAT>85%) enjoyed a 77% chance of surgical success with phase I procedures and often avoided MMA. In contrast, severe OSA (RDI>60, LSAT<70) experienced only a 42% likelihood of success with phase I procedures and often needed MMA. The preoperative average RDI of those successfully treated was 48 which decreased to 9 after surgery and was statistically equivalent at 7 on CAP. The preoperative LSAT was 75 and increased to 86 after surgery and while on CPAP.

Those patients that were partly successful in the phase I Powell & Riley protocol were offered the phase II maxillo-mandibular advancement. These patients enjoyed a 97% chance of surgical success despite the fact that most of these patients had severe disease. The preoperative RDI was 68 dropping to 8 after surgery and 7 on CPAP. Likewise the LSAT before phase II surgery was 63 and increased to 87 after surgery and while on CPAP. Indeed the control of OSA induced respiratory events and fall in oxygen levels can be controlled equally well by surgery or CPAP therapy.

A select group of patients may require only one operation in order to be free of their OSA. Those patients with a small jaw, receding chin and “underbite” (retrognathia) might be expected to have a very high likelihood of surgical success by correction of the skeletal deficiency. In a study by Hochban, 95% (36 out of 38 patients) of a carefully select group of patients were cured of their apnea by upper and lower jaw advancement. These patients were specifically chosen so as to meet specific criteria for height/weight ratios and measured retrognathia of the mandible. The results have been durable with polysomnographic data showing stable sleep study parameters with a minimum of two year follow up. This approach has been confirmed in a recent study by Prinsell where 50 consecutive patients who underwent MMA, and other select procedures as the initial operation, enjoyed a success rate of 100%.

The Powell and Riley group showed that the surgical results appear to be stable over several years time. 90% (30/33) “have shown long-term surgical success.” The average follow up was 39 months with a preoperative RDI of 69.9 and long-term RDI of 7.7.

The durability of a surgical success is probably related to a stable weight. If one should gain weight, then OSA will likely return. The use of alcohol, tobacco or certain drugs, such as tranquilizers, sedatives or antihistamines can adversely impact on OSA control. Tobacco use is condemned for its adverse affects on lung function and strong association with cancer of the swallowing and breathing passages.

Surgery can be used to rescue patients who are unable to use CPAP or to avoid the need for prolonged CPAP treatment, but appropriate attention to weight stabilization, or weight loss and other lifestyle issues becomes a lifelong commitment to remain "cured" of OSA.

The material on this site should not be used to diagnose or treat sleep apnea or any other medical problem. If you feel you may have the disorder, please consult your physician.