Upper airway multilevel radiofrequency under local anesthesia can improve CPAP adherence for severe OSA patients

Objective: To evaluate the effect of upper airway radiofrequency (RF) tissue reduction under local anesthesia (LA) in severe obstructive sleep apnea (OSA) patients using continuous positive airway pressure (CPAP) in order to improve their compliance and adherence.Design: Thirty (30) patients were included in this randomized clinical trial, suffering from severe OSA seeking medical advice for better upper airway management while using CPAP. Multilevel RF tissue reduction at tongue base, soft palate and inferior nasal turbinates was done under LA in multiple sessions. The Apnea hypopnea index (AHI), arousal index, lowest SpO2, CPAP pressure, and CPAP using time were recorded pre-operatively and six months after the last RF session.Results: Post-operatively, there were significant reduction in AHI (86.03 +/- 20.5 vs. 54.65 +/- 16.6 p < 0.001), arousal index (71.14 +/- 17.7 vs. 35.90 +/- 11.8 p < 0.001), and CPAP Pressure (17.13 +/- 1.7 vs. 10.97 +/- 1.5 p < 0.001). Also there was a significant increase in the lowest SpO2 (60.2 +/- 0.2 vs. 75 +/- 0.1 p < 0.001), and CPAP using time in hours (1.57 +/- 0.56 vs. 3.75 +/- 0.41 p < 0.001). Visual analogue scale (VAS) for pain was recorded showing that all patients reported throat pain mainly in the first five post-operative days which was well controlled on analgesia.Conclusion and relevance: Upper airway multilevel RF tissue reduction of tongue base, soft palate and inferior nasal turbinates under local anesthesia significantly improves the tolerance and adherence of severe OSA patients using CPAP.