Last Updated: 2008-10-07 16:37:05 -0400 (Reuters Health)
A small study in obese patients with obstructive sleep apnea (OSA) suggests that upper airway surgery may enhance compliance with continuous positive airway pressure (CPAP) therapy.

"Although CPAP is the primary treatment choice for most patients with OSA, poor compliance remains the major obstacle to effectively managing these patients," write senior researcher Dr. Dennis Auckley and colleagues from Case Western Reserve University in Cleveland.

Just one prior study has examined CPAP compliance following upper airway surgery and the results suggested that the operation (uvulopalatopharyngoplasty) actually worsened compliance, the authors note. However, that study, unlike the present one, did not include a preoperative assessment of compliance.

The current study, reported in the Archives of Otolaryngology: Head and Neck Surgery for September, featured 11 patients with poor CPAP compliance (< 4 hours per night) who underwent noncurative upper airway surgery for anatomical obstruction.

With surgery, the average apnea-hypopnea index fell from 79.0 to 30.2 (p < 0.001), while the CPAP pressure setting dropped from 11.8 to 10.4 cm H2O (p = 0.09).

On average, CPAP compliance increased by 48.6 minutes, the authors note. Eight patients showed an improvement in compliance, including five with improvements of more than an hour.

"The reason for the improvement in CPAP compliance following surgery is not entirely clear, although a reduction in the severity of the underlying OSA as well as in the CPAP pressure setting required to control the OSA could have contributed," the authors conclude.

Arch Otolaryngol Head Neck Surg 2008;134:926-930.