Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea

Soares, Carolina Ferraz de Paula; Cavichio, Luciano; Cahali, Michel Burihan

doi:10.1002/lary.24312

Cited by 26 publications

(27 citation statements)

References 17 publications

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“…Although many patients with OSA worldwide have undergone upper airway surgery, studies of health improvements associated with such surgery are rare and have been conducted with small samples. De Paula Soares et al and Yu et al reported that blood pressure fell after surgery, and Li et al found that the improvements of certain lipids were associated with surgical treatments in OSA, which is in agreement with our data. In addition, these metabolic factors combine multiplicatively to increase the CVD risk .…”

Section: Discussionsupporting

confidence: 93%

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

Qian

Zou

et al. 2019

The Laryngoscope

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Objectives To evaluate the association between upper airway surgery and changes of cardiological metabolic biomarkers and the overall cardiovascular risk in obstructive sleep apnea (OSA), and to define factors associated with better cardiovascular outcomes. Methods A total of 161 patients with newly diagnosed OSA who underwent classical or modified uvulopalatopharyngoplasty with or without genioglossus advancement and hyoid suspension were included. The pre‐ and postoperative (at least 6 months later) assessments, including polysomnography, measurement of glucose and lipids, blood pressure, and overall cardiovascular risk (as estimated by Framingham Risk Scores), were compared. We accounted for multiple comparisons with the use of the Benjamini‐Hochberg correction. Results The mean follow‐up time was 2.5 ± 1.9 years. The apnea hypopnea index decreased significantly in the entire cohort (mean changes with 95% confidence intervals were [−25.3 (−29.5, −21.0) events/hour, P < 0.001]. We also noted decreases in the age‐adjusted Framingham Risk Scores [−2.5% (−4.0%, −1.0%), P < 0.001] as well as single cardiometabolic biomarkers, including glucose [−0.50 (−0.70, −0.30) mmol/L, P < 0.001], total cholesterol [−0.46 (−0.65, −0.28) mmol/L, P < 0.001], triglycerides [−0.56, (−0.99, −0.14) mmol/L, P = 0.014], low‐density lipoprotein cholesterol [−0.27, (−0.43, −0.11) mmol/L, P = 0.002], apolipoprotein B [−0.10 (−0.14, −0.07) g/L, P < 0.001], systolic blood pressure [−3.58 (−6.02, −1.14) mmHg, P = 0.007], and diastolic blood pressure [−3.25 (−5.47, −1.02) mmHg, P = 0.008] after surgery. Patients with preoperative metabolic abnormalities exhibited better postoperative risk profiles changes (P < 0.001). In addition, associations were found between Δapolipoprotein B, Δsystolic blood pressure, and improvements in nocturnal oxygen level after surgery. Conclusion OSA‐related upper airway surgery was associated with improvements in cardiological metabolic biomarker levels and the overall cardiovascular risk, especially in patients with both OSA and metabolic disorders. The changes in biomarker levels may be associated with improved oxygen saturation after surgery. Level of Evidence 4 Laryngoscope, 130:818–824, 2020

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Section: Discussionsupporting

confidence: 93%

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

Qian

Zou

et al. 2019

The Laryngoscope

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“…Previously published studies have shown that following surgical treatment for OSA, the AHI remained unchanged in some patients, but subjective symptoms were improved, possibly due to improvement in the MAD, and an improvement in the CT90 (the cumulative time to reach a SaO 2 <90%) was a better indicator than the AHI, indicating that the benefit of surgery include reduction in both the frequency and degree of apnea [ 14 , 15 ]. Therefore, the AHI alone may not be a sufficient method to evaluate the effect of surgery for OSA, especially in those procedures that are unlikely to have an impact on AHI (such as nasal septoplasty).…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study to Compare the Use of the Mean Apnea-Hypopnea Duration and the Apnea-Hypopnea Index with Blood Oxygenation and Sleep Patterns in Patients with Obstructive Sleep Apnea Diagnosed by Polysomnography

Zhan

Fang

et al. 2018

Med Sci Monit

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BackgroundThe apnea-hypopnea index (AHI) and the mean apnea-hypopnea duration (MAD) are used to measure the severity of the symptoms of obstructive sleep apnea (OSA). The aim of this study was to compare the use of the MAD with the AHI as indicators of clinical and demographic parameters, blood oxygenation, and sleep parameters in patients diagnosed with OSA by polysomnography (PSG).Material/MethodsA retrospective study included 511 patients with OSA diagnosed by PSG and who had the AHI and the MAD measured according to the guidelines from the American Academy of Sleep Medicine (AASM). The patients were divided into two groups: patients with a short MAD and with a long MAD, according to median duration, and using the inter-quartile range (IQR), as the data were not normally distributed. Clinical and demographic parameters were recorded. Pulse oximetry was used to measure blood oxygen saturation during sleep, sleep structure was recorded, and the Epworth Sleepiness Scale (ESS) questionnaire was used to measure daytime sleepiness.ResultsIn all 511 patients with OSA, the MAD was significantly, but weakly, correlated with the AHI (r=0.17, P<0.01), but showed no significant associations with patient age (r=0.08, P=0.06), body weight (r=0.014, P=0.75), and height (r=0.06, P=0.16). Patients with a long MAD or severe OSA (n=260) had significantly worse blood oxygen levels and sleep parameters.ConclusionsFor patients with severe OSA, this study showed that the MAD was a useful indicator of blood oxygenation and sleep parameters.

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“…[35][36][37][38] De Paula Seares et al showed in a small 18-patient group with OSA, that following upper airway surgery, the mean systolic pressure reduced by 7.4 mm Hg, whereas the mean diastolic pressure reduced by 4.2 mm Hg at a 6-month follow-up. 36 Lee et al demonstrated a decrease of between 6 and 10 mm Hg in 50 children with OSA, after adenotonsillectomy. 37 Similarly, in 78 children with OSA, Kuo et al showed a decrease in systolic pressure of between 5.4 to 10.9 mm Hg and diastolic pressure between 12.0 and 18.8 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

“…It is well accepted, as illustrated above, that CPAP usage does reduce BP; the caveat is that compliance is the issue and the patient has to use it throughout the night. Although there are not many published data on the effect of upper airway surgery in OSA patients on BP, most published data do show some marginal decrease in BP following surgery . De Paula Seares et al showed in a small 18‐patient group with OSA, that following upper airway surgery, the mean systolic pressure reduced by 7.4 mm Hg, whereas the mean diastolic pressure reduced by 4.2 mm Hg at a 6‐month follow‐up .…”

Section: Discussionmentioning

confidence: 99%

“…Although there are not many published data on the effect of upper airway surgery in OSA patients on BP, most published data do show some marginal decrease in BP following surgery . De Paula Seares et al showed in a small 18‐patient group with OSA, that following upper airway surgery, the mean systolic pressure reduced by 7.4 mm Hg, whereas the mean diastolic pressure reduced by 4.2 mm Hg at a 6‐month follow‐up . Lee et al demonstrated a decrease of between 6 and 10 mm Hg in 50 children with OSA, after adenotonsillectomy .…”

Section: Discussionmentioning

confidence: 99%

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Upper airway surgery for obstructive sleep apnea reduces blood pressure

Pang¹,

Pang²,

Pang³

et al. 2017

The Laryngoscope

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Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea

Cited by 26 publications

References 17 publications

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA

A Retrospective Study to Compare the Use of the Mean Apnea-Hypopnea Duration and the Apnea-Hypopnea Index with Blood Oxygenation and Sleep Patterns in Patients with Obstructive Sleep Apnea Diagnosed by Polysomnography

Upper airway surgery for obstructive sleep apnea reduces blood pressure

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