Impact of upper airway surgery on CPAP compliance in difficult-to-manage obstructive sleep apnea

Objective: To study the role of adjunctive upper airway surgery in obese patients with obstructive sleep apnea (OSA) who were poorly compliant with continuous positive airway pressure (CPAP) therapy. Design: Retrospective study of obese patients with OSA and documented poor CPAP compliance who underwent noncurative upper airway surgery for anatomical obstruction. Data collected included polysomnogram (PSG) parameters, CPAP settings and compliance, and surgical complications. Setting: An urban academic county hospital with an 8-bed sleep laboratory. Data were collected retrospectively from 2002 through 2005. Patients: Subjects who met the following criteria: (1) documented OSA (apnea-hypopnea index [AHI] >= 5.0) treated with CPAP therapy, (2) poor CPAP compliance (< 4 hours per night), (3) subjected to upper airway surgery, (4) repeated PSG after surgery revealed persistent OSA (AHI >= 5) requiring continued treatment with CPAP, and (5) availability of presurgery and postsurgery CPAP compliance data. Main Outcome Measure: Compliance with CPAP. Results: Data from 11 patients were available for analysis. Their PSG parameters revealed the mean AHI (79.0 before surgery vs 30.2 after surgery; P <. 001) and mean CPAP pressure setting (11.8 cm H(2)O before surgery vs 10.4 cm H(2)O after surgery; P=.09) improved following surgery. A mean increase of 48.6 minutes in CPAP compliance was noted after surgery (P=.03). Eight of the 11 patients improved their CPAP compliance following surgical intervention, including 5 who improved by more than 1 hour. Conclusion: Upper airway surgery in select patients with OSA may improve CPAP compliance and should be considered as a potential adjunctive therapeutic measure in poorly compliant patients with OSA.