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Sleep Medicine

Effect of Obstructive Sleep Apnea Surgery on Blood Pressure

Tuesday, October 3, 2023
9:33 AM - 9:39 AM East Coast USA Time
Location: 103A

    Presenting Author(s)

  • Akshay Tangutur, MS

    Medical Student
    Penn Otorhinolaryngology
    Pacific Palisades, California, United States

    • Co-Author(s)

  • ES

    Everett G. Seay, BS, RPSGT

    Research Program Manager
    Division of Sleep Surgery, Penn Otorhinolaryngology
    Philadelphia, PA, United States

  • Brendan T. Keenan, MS

    Co-Director
    Biostatistics Core, Division of Sleep Medicine
    Philadelphia, PA, USA

  • Erica R. Thaler, MD

    Professor and Vice Chair
    Penn Otorhinolaryngology
    Philadelphia, PA, United States

    • Senior Author(s)

  • Raj C. Dedhia, MD, MSCR

    Associate Professor of Otorhinolaryngology & Medicine
    Division of Sleep Surgery, Penn Otorhinolaryngology
    Philadelphia, PA, United States

Disclosure(s):
Akshay Tangutur, MS: No relevant relationships to disclose.
Erica R. Thaler, MD: No relevant relationships to disclose.
Raj C. Dedhia, MD, MSCR: No relevant relationships to disclose.
Introduction: The first-line treatment for obstructive sleep apnea (OSA) is positive airway pressure (PAP) therapy, which reduces cardiovascular risk for adherent patients. Surgery is a therapeutic option for PAP-intolerant patients, but has shown mixed effects on cardiovascular endpoints. Here, we evaluated the effect of upper airway surgery on cardiovascular outcomes in patients with OSA.

Methods: Seventy-four patients underwent definitive surgery, including: tonsillectomy, epiglottidectomy, modified uvulopalatopharyngoplasty, maxillary expansion, and maxillo-mandibular advancement. Twenty-four hour ambulatory blood pressure (ABP), peripheral arterial tonometry (PAT)-based home sleep study, and sleep-related patient-reported outcomes (PROs) were captured pre-operatively and at six months post-operatively. Paired T-tests were used to evaluate changes in outcomes after surgery.

Results: Forty-one patients successfully completed pre- and post-operative assessments. Patients were generally middle-aged (43.8±12.5 years), obese (BMI 33.0±5.8 kg/m2), male (68%), White (71%), and had severe OSA (apnea-hypopnea index [AHI] 33.9±29.5 events/hour). AHI decreased by an average of 19.9 (95% CI: 12.2, 27.2) events/hour after surgery (p < 0.01), and BMI decreased by 1.00 (0.12, 1.88) kg/m2 (p=0.028). All sleep-related PROs showed large and significant improvements (effect sizes from 0.88 to 1.64) after surgery. On average, we found clinically-meaningful reductions in nocturnal systolic (-1.95 mmHg; p=0.25) and nocturnal diastolic (-2.30 mmHg; p=0.10) blood pressure, but results were not statistically significant in our relatively small sample.

Conclusions: While surgical therapy for OSA demonstrated dramatic improvement in polysomnographic and sleep-related outcomes, we did not find statistically significant improvements in blood pressure. Clinically-meaningful changes in nocturnal blood pressure were observed on average, supporting the need for further investigation in larger samples to understand possible mechanisms between OSA surgery and improvement in cardiovascular outcomes.