Multilevel Upper Airway Surgery Reduces Blood Pressure in OSA Patients

Does upper airway surgery reduce blood pressure in patients with obstructive sleep apnea (OSA)?

Bottom Line: Upper airway surgery achieves a clinically significant decrease in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with OSA.

Background: Multilevel upper airway surgery (similar to continuous positive airway pressure [CPAP] therapy) for OSA has been shown to be more efficacious in this recent decade. There is a demonstrated strong link between OSA and hypertension. The main goal of OSA therapy should not be to reduce apnea/hypopnea index (AHI) scores, but rather to improve target outcome measures and end-organ damage, most commonly considered to be hypertension (HTN).

Study design: Prospective series of 112 consecutive OSA patients with HTN.

Setting: Department of Otorhinolaryngology Head and Neck Surgery, Asia Sleep Center, Singapore.

Synopsis: The mean preoperative respiratory disturbance index for patients was 40, AHI was 32.6, with the mean lowest oxygen saturation of 79.9%. The mean preoperative and postoperative SBP (adjusted and controlled for BMI, age, race, and gender) dropped from 146 ± 15.3 mm Hg to 122 ± 12.5 mm Hg. The mean preoperative and postoperative adjusted DBP dropped from 91 ± 10.2 mm Hg to 76 ± 7.8 mm Hg. Epworth Sleepiness Scale (ESS) scores improved from 11.54 ± 4.1 to 4.88 ± 1.4; visual analogue scale (VAS) snore scores improved from 7.7 ± 0.8 to 2.3 ± 0.9. All OSA severity groups (normal AHI (4); mild OSA (26); moderate OSA (28); severe OSA (54)) saw adjusted SBP and DBP postoperative decreases. Of note, 58 out of 112 patients did not require their antihypertensive medications anymore and were normotensive. An additional 31 patients were on half their initial preoperative dosage and/or reduced their preoperative antihypertensive dosage. Limitations included the small sample size, the fact that most patients were Asian, a 16-month follow-up, and lack of a postoperative sleep test for all patients.

Citation: Pang KP, Pang EB, Pang KA, Vicini C, Chan YH, Rotenberg BW. Upper airway surgery for obstructive sleep apnea reduces blood pressure. Laryngoscope. 2018;128:523–527.