A long-term study of patients who had upper airway surgery has confirmed the benefits for better management of moderate to severe sleep apnea for people who failed to adapt or are not suited to continuous positive pressure airway (CPAP) therapy, say Flinders University and other experts.

Follow-up checks with 36 of the first 48 patients who had sleep apnea multilevel surgery (SAMS)—which involves repositioning the palate along with minimally invasive tongue volume reduction to increase upper airway flow—found consistently positive improvement in their sleep apnea symptoms up to three years later, according to the research published in Sleep.

“The benefits include less disrupted sleep and daytime drowsiness, less snoring in some cases, and better general health, an important consideration given we know sleep loss can lead to diabetes, cardiovascular and stroke, obesity, depression and anxiety, and other issues,” says professor Simon Carney, MD, an ear, nose, and throat specialist at Flinders, in a release. “It’s very exciting to see so many patients who had the surgery getting a better night’s sleep with reduced snoring that is likely to lead to fewer long-term health risks.”

Carney continues in the release, “Clarity about the long-term benefits of pharyngeal airway surgery is necessary because the alternative CPAP or a mandibular advancement splint are affected by usage, and real-life effectiveness of these therapies are often suboptimal. If patients receive inadequate treatment, their lifestyle is impacted, and they are at risk of serious long-term morbidity.”

Carney says the selective use of this palate surgery can substantially reduce the number of night-time apnea events without the need for CPAP machines.

About half the 102 people recruited for the SAMS trial were randomly assigned the surgery while the rest continued to receive the best possible medical treatment. After six months, those who received the surgery had an approximate 60% decrease in the frequency of throat obstructions at night, compared with a 20% decrease in participants who remained on medical treatment, and had major added improvements in snoring, daytime sleepiness, and general health status.

After two to three years, the follow-up study found the surgical results remained stable despite concerns the expected benefits from the upper airway surgery would reduce over time.

The trial participants were recruited from six clinical centers in three Australian states and were mainly overweight males with severe obstructive sleep apnea who could not satisfactorily use standard medical treatments.

While some patients reported minor taste and swallow complaints after the surgery, most unanimously had an improved quality of life and a high level of satisfaction overall.

Carney is now running further research to establish which patients are most likely to benefit from surgery. The study is part of research led by Flinders FHMRI sleep health professor Peter Catcheside, PhD, to identify the site of airway collapse using minimally invasive technology and artificial intelligence. 

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