Like most surgical treatments throughout medicine, research studies typically evaluate short-term outcomes. In sleep surgery, most studies report results at 3-6 months following surgery. There are notable exceptions – including 5-year outcomes reported for Inspire Upper Airway Stimulation in the STAR Trial presented at the Sleep 2017 meeting and then published in the medical journal Otolaryngology – Head and Neck Surgery. However, more broadly we do not know as much about long-term results. There are many reasons. The most important is that patients generally have postoperative sleep studies about 3-6 months after surgery, making it easy to report data in research studies. Another is that patients who are doing well after surgery often do not want to pay for sleep studies, resulting in sleep studies being performed later not an accurate assessment of long-term surgery results because they are generally done in patients who are not doing well. Finally, long-term studies are much more expensive than one would expect, as they require dedicated personnel to remain in close contact with study participants, not to mention the costs of the sleep studies themselves.
Recently-Published Research from Spain
A study published this month in the medical journal European Archives of Otorhinolaryngology from some colleagues in Valencia, Spain, including Marina Carrasco-Llatas, MD, PhD, sheds some light on this important question. Among patients undergoing a wide variety of surgeries and followed for up to 4 years, there was a notable improvement in objective measures of obstructive sleep apnea (from about 35 to 15 breathing events/hour, on average) that was stable at 8, 34, and 48 months, all without changes in body mass index. Similarly, there were meaningful improvements in subjectives measures of sleepiness and quality of life, important outcomes themselves. There was a suggestion that newer soft palate surgery techniques like expansion sphincter pharyngoplasty had better outcomes than traditional uvulopalatopharyngoplasty.
My Experience: Avoid Weight Gain
Many patients ask me about long-term results of surgery, so I have thought quite a bit about this myself and reflected on the experience of my own patients. My strong feeling is that patients who do well after sleep apnea surgery typically have their benefits hold up well over time unless something happens that would be expected to worsen their sleep apnea, such as weight gain. I like to think that I have a good understanding of any changes in a good outcome, as I certainly encourage my patients to let me know if their good outcome worsens. If this does occur, we work together to figure out why this may have occurred and what can be done.
There are a few papers looking at long-term outcomes of older sleep apnea surgical procedures like traditional uvulopalatopharyngoplasty, showing long-term results that are not good. However, these papers have not only used older techniques in a one-size-fits-all approach but also, more importantly, include patients that never had a good outcome after surgery in the first place. A poor outcome after surgery will not spontaneously improve over time unless there is something favorable like weight loss, so including those patients does not answer the important question here. What we really care about is how long someone with a good outcome will maintain that benefit, and my experience agrees with this paper from the Spanish group.