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Mortality of veterans with sleep apnea: CPAP versus uvulopalatopharyngoplasty
Scientific Session—Monday
Results: There was no significant difference in median healing rate. In each group the median was between the third and fourth month. Persistent scarring was seen at 2 years in four control ears and no mitomycin ears (P ⫽ 0.02), but this was of no clinical significance. Normal hearing thresholds were obtained in all children at 2 years’ follow-up. Conclusions: CLAM proved to be an effective method for short-term ventilation, but topical mitomycin C before CLAM did not prolong the patency rate in our patients. No significant complication was encountered at 2 years’ follow-up.
Room OCCC 110AB •
Scientific Session: Sleep Disorders Serge A Martinez MD; B Tucker Woodson MD (moderators)
9:30
AM
Mortality of Veterans with Sleep Apnea: CPAP versus Uvulopalatopharyngoplasty Edward M Weaver MD MPH (presenter); Charles Maynard PhD; Bevan Yueh MD MPH Seattle WA; Seattle WA; Seattle WA
Objectives: Untreated obstructive sleep apnea appears to increase mortality. Provision of continuous positive airway pressure (CPAP) is first-line treatment and is thought to reduce the mortality risk. Uvulopalatopharyngoplasty (UPPP) is one common second-line treatment of unclear long-term effectiveness. We sought to determine whether providing a CPAP device is associated with a decreased mortality rate relative to UPPP surgery in sleep apnea patients. Methods: This retrospective cohort study included all sleep apnea patients treated with either CPAP or UPPP in any Veteran Affairs (VA) facility 1991-2001. Subjects were identified by CPT codes in the VA Outpatient Care and Patient Treatment Files. Mortality data were extracted from VA Death Files. Treatment groups were compared on final vital status with logistic regression and on mortality hazard with Cox regression, adjusting for age, sex, race, comorbidity, and date treatment was initiated. Sleep apnea severity data were not available. Results: There were 28,612 CPAP patients and 3,977 UPPP patients. At conclusion, 3,256 CPAP patients (11.4%) and 394 UPPP patients (9.9%) were dead (P ⫽ 0.006). After adjusting for variables listed, CPAP patients had 56% (95% CI, 20%-101%; P ⫽ 0.001) greater odds of being dead at the end of the data period and a 55% (95% CI, 21%-98%; P ⬍ 0.001) higher probability of dying at any time, relative to UPPP patients. Conclusions: Without adjusting for sleep apnea severity, UPPP appears to confer a favorable long-term mortality risk relative to providing CPAP in sleep apnea patients. Future research will compare mortality adjusting for baseline disease severity.
9:38
AM
A Comparison of Polysomnography (PSG) and a Portable Home Sleep Study in the Diagnosis of OSAS in Adults Stephanie Su MD (presenter); Dana L Suskind MD; Fuad M Baroody MD; Michael Kohrman MD Chicago IL; Chicago IL; Chicago IL; Chicago IL
Objectives: OSAS is increasingly recognized as a significant contributor to neurocognitive and cardiovascular sequelae. While PSG is the gold standard for diagnosis, its limited availability, long waiting lists, and high cost make at-home sleep studies an attractive alternative. We sought to evaluate a commercially available at-home sleep study (SNAP) in comparison to standard polysomnography for the diagnosis of OSAS in adults. Methods: A prospective evaluation of 60 adult patients referred for a PSG to rule out OSAS. Simultaneous SNAP and PSG studies were conducted. Both studies were read and scored according to predetermined criteria by independent investigators blinded to the results of the other evaluation. Results: Interpretable data were available for both techniques in 50 of 60 patients. There were 32 females (64%) and 18 males (36%) with an age range from 20 to 69 years. The Respiratory Disturbance Index (RDI) was 27 ⫹ 4.2 with PSG and 21 ⫹ 4.0 using SNAP (mean ⫹ SEM). The correlation coefficient between RDI obtained using both tests was rs ⫽ 0.81 (P ⫽ 0.0001). When compared to PGS, sensitivity and specificity for SNAP were 84% and 100% for an RDI ⬎5, and 88% and 84% for an RDI ⬎15, respectively. Conclusions: Our data show a strong and significant correlation between RDIs obtained from both studies and a good sensitivity and specificity of SNAP compared to PSG. While SNAP does not provide data about stages of sleep and endtidal CO2 levels, our data suggest that it is a useful alternative for PSG in the diagnosis of OSA. Furthermore, it offers the advantages of performance in the home setting. 9:46
AM
The Mannheim Protocol of Multi-Level Surgery for Obstructive Sleep Apnea Thomas Verse MD (presenter); Joachim T Maurer MD; Carsten Schroen MD; Boris A Stuck MD; Gerhard Hein MD; Karl Hoermann MD Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany
Objectives: Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). Unfortunately, nCPAP does not exceed long-term compliance rates of more than 60%. Therefore, surgical strategies are of growing interest in this field. Today, so-called multi-level surgeries are favored
MONDAY
P84
Otolaryngology– Head and Neck Surgery August 2003
Results: There was no significant difference in median healing rate. In each group the median was between the third and fourth month. Persistent scarring was seen at 2 years in four control ears and no mitomycin ears (P ⫽ 0.02), but this was of no clinical significance. Normal hearing thresholds were obtained in all children at 2 years’ follow-up. Conclusions: CLAM proved to be an effective method for short-term ventilation, but topical mitomycin C before CLAM did not prolong the patency rate in our patients. No significant complication was encountered at 2 years’ follow-up.
Room OCCC 110AB •
Scientific Session: Sleep Disorders Serge A Martinez MD; B Tucker Woodson MD (moderators)
9:30
AM
Mortality of Veterans with Sleep Apnea: CPAP versus Uvulopalatopharyngoplasty Edward M Weaver MD MPH (presenter); Charles Maynard PhD; Bevan Yueh MD MPH Seattle WA; Seattle WA; Seattle WA
Objectives: Untreated obstructive sleep apnea appears to increase mortality. Provision of continuous positive airway pressure (CPAP) is first-line treatment and is thought to reduce the mortality risk. Uvulopalatopharyngoplasty (UPPP) is one common second-line treatment of unclear long-term effectiveness. We sought to determine whether providing a CPAP device is associated with a decreased mortality rate relative to UPPP surgery in sleep apnea patients. Methods: This retrospective cohort study included all sleep apnea patients treated with either CPAP or UPPP in any Veteran Affairs (VA) facility 1991-2001. Subjects were identified by CPT codes in the VA Outpatient Care and Patient Treatment Files. Mortality data were extracted from VA Death Files. Treatment groups were compared on final vital status with logistic regression and on mortality hazard with Cox regression, adjusting for age, sex, race, comorbidity, and date treatment was initiated. Sleep apnea severity data were not available. Results: There were 28,612 CPAP patients and 3,977 UPPP patients. At conclusion, 3,256 CPAP patients (11.4%) and 394 UPPP patients (9.9%) were dead (P ⫽ 0.006). After adjusting for variables listed, CPAP patients had 56% (95% CI, 20%-101%; P ⫽ 0.001) greater odds of being dead at the end of the data period and a 55% (95% CI, 21%-98%; P ⬍ 0.001) higher probability of dying at any time, relative to UPPP patients. Conclusions: Without adjusting for sleep apnea severity, UPPP appears to confer a favorable long-term mortality risk relative to providing CPAP in sleep apnea patients. Future research will compare mortality adjusting for baseline disease severity.
9:38
AM
A Comparison of Polysomnography (PSG) and a Portable Home Sleep Study in the Diagnosis of OSAS in Adults Stephanie Su MD (presenter); Dana L Suskind MD; Fuad M Baroody MD; Michael Kohrman MD Chicago IL; Chicago IL; Chicago IL; Chicago IL
Objectives: OSAS is increasingly recognized as a significant contributor to neurocognitive and cardiovascular sequelae. While PSG is the gold standard for diagnosis, its limited availability, long waiting lists, and high cost make at-home sleep studies an attractive alternative. We sought to evaluate a commercially available at-home sleep study (SNAP) in comparison to standard polysomnography for the diagnosis of OSAS in adults. Methods: A prospective evaluation of 60 adult patients referred for a PSG to rule out OSAS. Simultaneous SNAP and PSG studies were conducted. Both studies were read and scored according to predetermined criteria by independent investigators blinded to the results of the other evaluation. Results: Interpretable data were available for both techniques in 50 of 60 patients. There were 32 females (64%) and 18 males (36%) with an age range from 20 to 69 years. The Respiratory Disturbance Index (RDI) was 27 ⫹ 4.2 with PSG and 21 ⫹ 4.0 using SNAP (mean ⫹ SEM). The correlation coefficient between RDI obtained using both tests was rs ⫽ 0.81 (P ⫽ 0.0001). When compared to PGS, sensitivity and specificity for SNAP were 84% and 100% for an RDI ⬎5, and 88% and 84% for an RDI ⬎15, respectively. Conclusions: Our data show a strong and significant correlation between RDIs obtained from both studies and a good sensitivity and specificity of SNAP compared to PSG. While SNAP does not provide data about stages of sleep and endtidal CO2 levels, our data suggest that it is a useful alternative for PSG in the diagnosis of OSA. Furthermore, it offers the advantages of performance in the home setting. 9:46
AM
The Mannheim Protocol of Multi-Level Surgery for Obstructive Sleep Apnea Thomas Verse MD (presenter); Joachim T Maurer MD; Carsten Schroen MD; Boris A Stuck MD; Gerhard Hein MD; Karl Hoermann MD Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany; Mannheim Germany
Objectives: Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). Unfortunately, nCPAP does not exceed long-term compliance rates of more than 60%. Therefore, surgical strategies are of growing interest in this field. Today, so-called multi-level surgeries are favored
MONDAY
P84
Otolaryngology– Head and Neck Surgery August 2003