Loop Gain Predicts the Response to Upper Airway Surgery in Patients With Obstructive Sleep Apnea
| Autor: | Anthony Turton, Shane A. Landry, D. Mann, Philip I. Terrill, Glen Burgess, Bradley A. Edwards, Darren Mansfield, Paul Leong, Simon A. Joosten, Scott A. Sands, Jhanavi Rangaswamy, Garun S. Hamilton, Christopher Andara |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Polysomnography Respiratory System Arousal Ventilatory control 03 medical and health sciences Upper airway surgery 0302 clinical medicine Physiology (medical) medicine Humans In patient Surgical treatment Retrospective Studies Sleep Apnea Obstructive business.industry Middle Aged medicine.disease Prognosis respiratory tract diseases Obstructive sleep apnea Treatment Outcome Editorial 030228 respiratory system Anesthesia Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Sleep. 40(7) |
| ISSN: | 1550-9109 |
| Popis: | Upper airway surgery is often recommended to treat patients with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airways pressure. However, the response to surgery is variable, potentially because it does not improve the nonanatomical factors (ie, loop gain [LG] and arousal threshold) causing OSA. Measuring these traits clinically might predict responses to surgery. Our primary objective was to test the value of LG and arousal threshold to predict surgical success defined as 50% reduction in apnea-hypopnea index (AHI) and AHI10 events/hour post surgery.We retrospectively analyzed data from patients who underwent upper airway surgery for OSA (n = 46). Clinical estimates of LG and arousal threshold were calculated from routine polysomnographic recordings presurgery and postsurgery (median of 124 [91-170] days follow-up).Surgery reduced both the AHI (39.1 ± 4.2 vs. 26.5 ± 3.6 events/hour; p.005) and estimated arousal threshold (-14.8 [-22.9 to -10.2] vs. -9.4 [-14.5 to -6.0] cmH2O) but did not alter LG (0.45 ± 0.08 vs. 0.45 ± 0.12; p = .278). Responders to surgery had a lower baseline LG (0.38 ± 0.02 vs. 0.48 ± 0.01, p.05) and were younger (31.0 [27.3-42.5] vs. 43.0 [33.0-55.3] years, p.05) than nonresponders. Lower LG remained a significant predictor of surgical success after controlling for covariates (logistic regression p = .018; receiver operating characteristic area under curve = 0.80).Our study provides proof-of-principle that upper airway surgery most effectively resolves OSA in patients with lower LG. Predicting the failure of surgical treatment, consequent to less stable ventilatory control (elevated LG), can be achieved in the clinic and may facilitate avoidance of surgical failures. |
| Databáze: | OpenAIRE |
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