Evaluating Risks of Surgery for Sleep Apnea

Individuals with obstructive sleep apnea repeatedly stop breathing during the night due to upper airway obstruction. This condition is very common, as common as adult diabetes, and affects more than 12 million Americans, according to the National Institutes of Health. Risk factors include being male, overweight and over the age of 40, but sleep apnea can strike anyone at any age, even children. Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotence, headaches and even death. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle accidents. Although the risk of serious complication following corrective surgery for sleep apnea is relatively low, the surgery is more risky in certain groups of patients with other medical problems, high body mass index (a measure of obesity) and more severe obstructive sleep apnea, according to a study led by UCSF Assistant Professor in Residence Eric J. Kezirian, MD, MPH, in the October issue of Archives of Otolaryngology - Head and Neck Surgery, published by the Journal of the American Medical Association. 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. Earlier work from Kezirian and his colleagues had shown that about 1.6 percent of all patients undergoing such procedures have serious complications, including 0.2 percent who die within 30 days. Previous reports about the risk factors for complications had been conflicting. In Kezirian and his colleagues' latest research, they studied 3,130 patients who underwent UPPP between 1991 and 2001 at United States Veterans Affairs medical centers. The researchers utilized data about participants' surgeries and characteristics from medical records. Data on body mass index, other illnesses and the severity of sleep apnea were collected from the medical charts of a smaller group of patients, including 51 (1.6 percent) 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 have serious complications. In the larger group of 3,130 patients, the most important risk factor for serious complication was the presence of other serious medical conditions at the time of surgery. For each additional serious 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 complication. "While most patients do not have complications following sleep apnea surgery, it is important to know which patients may be at greatest risk," Kezirian said. "I hope this research will improve the ability of surgeons to discuss the potential risks with patients and, in many cases, take additional steps or precautions to make the surgery even safer."

Related Links: UCSF Sleep Surgery Division, Department of Otolaryngology - Head and Neck Surgery