Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients
Pang KP (1), Baptista PM (2), Olszewska E (3), Braverman I (4), Carrasco-Llatas M (5), Kishore S (6), Chandra S (7), Yang HC (8), Wang CMZ (1), Chan YH (9), Pang KA (1), Pang EB (10), Rotenberg B (11).
(1) Otolaryngology Department, Asia Sleep Centre, Paragon, Singapore.
(2) Otolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain.
(3) Ear, Nose, and Throat Department, Medical University of Bialystok, Bialystok, Poland.
(4) Department of Otolaryngology-Head and Neck Surgery, Hillel Yaffe Medical Center, Technion Faculty Medicine, Haifa, Israel.
(5) Ear, Nose, and Throat Department, Hospital Universitario Dr. Peset, Valencia, Spain.
(6) Otolaryngology Department, Nova Specialty Hospital, Hyderabad, India.
(7) Ear, Nose, and Throat Department, Belle Vue Clinic and Hospital, Kolkata, India.
(8) Otolaryngology Department, Chonnam National University Hospital, Gwangju, South Korea.
(9) Biostatistics Unit, School of Medicine, National University Singapore, Singapore.
(10) Medicine Faculty, University of Glasgow, Glasgow, United Kingdom.
(11) Otolaryngology Department, Western University, London, Ontario, Canada.
Our objective was to determine whether drug-induced sleep apnea (DISE) affects the successfulness of the surgical outcome.
Prospective, seven-country, nonrandomized trial.
There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group.
There were 170 patients in the DISE group and 156 patients in no-DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no-DISE group it was 28.1 ± 3.9 (P = .23).
The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no-DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no-DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea-hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no-DISE group it was 33.7 ± 19.6 (P = .61).
The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no-DISE group it was 13.2 ± 8.8 (P = .023). The age-, gender-, BMI-adjusted percentage change in AHI for the DISE group was -48.4 ± 31.9, whereas in the no-DISE group it was -59.8 ± 18.6 (P < .001).
The age-, gender-, and BMI-adjusted success rate for the DISE group was 66.5%, whereas in the no-DISE group it was 80.8% (P = .004). The age-, gender-, and BMI-adjusted change in SBP for the DISE group was -6.1 ± 8.6, whereas in the no-DISE group it was -13.3 ± 11.1 (P < .001). The age-, gender-, and BMI-adjusted change in DBP in the DISE group was -5.2 ± 12.1, whereas in the no-DISE group it was -12.4 ± 11.7 (P < .001).
The mean age- and gender-adjusted change in BMI for the DISE group was -4.6 ± 12.9, whereas in the no-DISE group it was -6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08.
DISE may not significantly affect surgical success in OSA.
CITA DEL ARTÍCULO Laryngoscope. 2019 Apr 17. doi: 10.1002/lary.27987