Multilevel Surgery for OSA Has Increased

How have the patterns of surgical sleep procedures used to treat obstructive sleep apnea (OSA) changed over time?

Background: The majority of OSA is undiagnosed, which has led to a greater focus on medical and surgical treatment. Traditional surgical OSA treatment focused almost exclusively on tonsil removal, uvulopalatopharyngoplasty (UPPP) and tracheotomy. Multilevel sleep surgery, addressing both the palate and the hypopharynx, is now often discussed as first-line surgical therapy for OSA.

Study design: Repeated cross-sectional study of discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality for 232,470 patients who underwent nasal, palatal, or hypopharyngeal procedures for sleep-disordered breathing or OSA from 1993 to 2010.

Setting: Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore.

Synopsis: The study period was divided into two time intervals: 1993–2000 (97,363 cases; 15% obese) and 2001–2010 (135,107 cases; 26% obese). Palatal surgery was the most common sleep surgical procedure performed, followed by nasal surgery. There were several changes in the 2001–2010 group, compared to the 1993–2000 group: Sleep surgery was performed significantly more often for an OSA diagnosis and in obese patients; hypopharyngeal surgical procedures and multilevel surgery increased significantly; nasal and palatal surgery decreased; and patients undergoing tracheostomy were more likely to have two or more comorbidities than OSA patients undergoing other procedures. Lower-volume surgeons performed the majority of sleep surgery; study authors believe this may indicate a broader comfort of general otolaryngologists in performing sleep surgery. Limitations included a lack of follow-up data beyond the index admission, a 30-day post-operative window, and no information on OSA stage or severity, previous surgical procedures or long-term outcomes.

Bottom line: There has been a significant increase in multilevel sleep surgery procedures that address the nasal and hypopharyngeal airway.

Citation: Ishman SL, Ishii LE, Gourin CG. Temporal trends in sleep apnea surgery: 1993–2010; Laryngoscope. 2014;124:1251-1258.