A clinical study of surgical outcomes in patients with obstructive sleep apnoea syndrome

Snoring & Obstructive Sleep Apnea Syndrome (OSAS) is a globally prevalent problem which is increasingly being recognized in recent times. The treatment modalities include medical appliances & surgery. It is mandatory to have a rational approach in the management of Obstructive Sleep Apnoes. Patients are given Continuous Positive Airway Pressure (CPAP) support or advised surgical correction as per the level of obstruction diagnosed by sleep MRI and the severity as per the polysomnography. A judicious selection of cases needs to be done for surgical management. Patients unfit for surgery and those who prefer medical treatment are advised CPAP as the primary modality of treatment. A small group of patients need surgical intervention followed by CPAP support.

To assess the outcomes of various surgical procedures in the management of OSAS and to define a comprehensive protocol for objective assessment of OSAS with Dynamic MRI and polysomnography. Materials & Methods: A cohort of 100 patients in the age group 27 – 64 years were diagnosed with OSAS and were treated at our institute over a period of one year (January 2010 – January 2011). All patients were evaluated with Epworth sleepiness scale (ESS) and investigated with Dynamic MRI and polysomnography. As per the management protocols defined in the study, surgery was performed in 38 patients with severe compromise of the airway, while the other group of 62 patients, were provided CPAP. The 38 patients selected for surgery were included into this prospective study. Successful outcomes among these 38 patients were analyzed at the end of the study period. Four patients with mixed apnoea required multimodal therapy which included surgery followed by CPAP support.

Among the 38 patients, surgical treatment proved successful in 34 patients in whom AHI reduced from 38.27 to 14.54 (62%) and ESS improved by almost 10 points. Four patients among the surgical group had persistence of symptoms due to persistence of mixed apnoea & they were given CPAP support. Inferences derived from the above results proved the success of various surgical interventions in the management of OSAS.

A critical analysis of the anatomical & physiological factors inducing obstructive episodes & an appropriate treatment plan is vital, to produce successful outcomes in patients with OSAS. Failure of surgical procedures, are often due to improper case selection. A small group of patients may require multimodal therapy with surgery and CPAP.