Patients undergoing surgery to correct sleep apnea are more likely to have complications if their condition is severe, they have a high body mass index, they have other medical problems or they are undergoing certain other surgical procedures at the same time, according to a report in the October issue of Archives of Otolaryngology – Head & Neck Surgery, one of the JAMA/Archives journals.
Individuals with sleep apnea repeatedly stop breathing during the night due to upper airway obstruction, according to background information in the article. Sleep apnea contributes to an increased risk of cardiovascular disease, poor quality of life and death. A procedure known as uvulopalatopharyngoplasty (UPPP), during which surgeons remove the uvula and other soft tissues at the back of the throat to help clear the airway, is the most common operation performed to alleviate sleep apnea. About 1.6 percent of all patients undergoing such procedures have serious complications, including .2 percent who die within 30 days. Previous reports about the risk factors for complications have been conflicting.
Eric J. Kezirian, M.D., M.P.H., University of California, San Francisco, and colleagues studied 3,130 consecutive adults (97 percent men, average age 50) in patients who underwent UPPP between 1991 and 2001 at the United States Veterans Affairs medical centers. The researchers gathered data about participants' surgeries and characteristics from medical records. Data on body mass index (BMI), other illnesses and the severity of sleep apnea was collected from medical charts for a smaller group of patients, including all 51 (1.6 percent) of the original group who had serious complications and 212 others who did not have serious complications but were the same sex and age, had the same number of procedures performed at the same time and had surgery the same year as those who did.
In the larger group of 3,130 patients, those who had more severe sleep apnea, who had additional non-nasal surgeries at the same time and had other medical conditions were more likely to have serious complications following surgery. For each additional illness besides sleep apnea that a patient had, his or her risk for complications almost doubled. In the smaller group of patients, more severe sleep apnea, higher body mass index and the presence of other illnesses were associated with a higher risk for complications when they were all considered together. However, based on the small number of participants with complications, the researchers could not determine if each was an risk factor on its own. Having retrolingual surgery (certain procedures involving the tongue, epiglottis or jaw) at the same time as UPPP was independently associated with having complications following the operation. Lowest oxygen saturation, a measure of how much oxygen red blood cells are carrying, also was not associated with complications.
"Apnea-hypopnea index [a measure of sleep apnea severity], body mass index and medical comorbidity [other illness] were each associated with serious complication; however, the low complication rate precluded demonstration of associations independent of each other," the authors conclude. "Concurrent retrolingual procedures were also associated with serious complication, but the cumulative risk of separate retrolingual procedures is unknown."
(Arch Otolaryngol Head Neck Surg. 2006;132:1091-1098. Available pre-embargo to the media at www.jamamedia.org.)
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