Patients ask me all the time about the chances that their sleep apnea surgery will work. Here, I want to explain my approach to answering that question and the reasons for my answer.

Most medical research examines short-term outcomes, typically less than 6 months. This limitation to short-term results is especially true for surgery, including sleep apnea surgery. There are some longer-term studies of sleep apnea surgery, including 5-year outcomes of Inspire Upper Airway Stimulation that I have discussed in a previous blog post. However, there are more studies of short-term outcomes of sleep apnea surgery because these studies are just easier to perform, for many reasons. First, patients are often seen for follow up visits within the first 6 months, so there is a natural opportunity to evaluate results. Second, patients want to know their results as soon as it makes sense, leading to tests after surgery (like a postoperative sleep study) being performed relatively soon after surgery. Third, some tests looking at longer-term outcomes (like sleep studies) are only done in patients who are not doing well, leading to a bias towards poor  sleep apnea surgery outcomes.

In spite of these limitations, it is good to look at the sleep apnea surgery studies that do evaluate long-term results. Outcomes of sleep apnea surgery can be measured objectively (comparing the preoperative and postoperative sleep studies) and subjectively (questions related to snoring, sleepiness, fatigue, etc.). Subjective outcomes can be affected by a placebo effect. In the case of sleep apnea surgery, the placebo effect could occur because someone undergoing surgery subconsciously wants to have improvement (there was a reason for them to undergo sleep apnea surgery in the first place) and reports that they must have had an improvement, even if this might not have occurred. This would be a reason to minimize sleep apnea surgery studies of subjective outcomes. At the same time, treating sleep apnea is often based on subjective outcomes. For a patient having difficulty functioning on a daily basis, their sleepiness or fatigue may be exactly what matters most to them. In fact, the clearest evidence that sleep apnea treatments (including CPAP and sleep apnea surgery) help patients is in improving these subjective outcomes.

Research about sleep apnea surgery and subjective outcomes

It is common for many research studies focusing on a research question to have slightly different conclusions. In these cases, the scientific technique of meta-analysis is an attempt to combine the data to determine what the studies show as a group. In the cases of sleep apnea surgery, there are multiple published studies evaluating subjective outcomes over time. A recent study used meta-analysis to combine studies of subjective outcomes after soft palate surgery without tonsillectomy. They focused on soft palate surgery without tonsillectomy because soft palate surgery is common, and research has shown that tonsillectomy (specifically, tonsil size) is a major predictor of outcomes of soft palate that also includes tonsillectomy. The meta-analysis had the following key findings:

• Meaningful difference in daytime sleep apnea (Epworth Sleepiness Scale decrease of 3.3 points)
• Meaningful decrease in snoring (4.1 points on a 10-point scale)
• Contemporary soft palate surgery techniques that focus on tissue repositioning are associated with greater improvements in daytime sleepiness and snoring
• No evidence of a decrease in these improvements over time

What is my sleep apnea surgery experience?

My own experience with soft palate surgery agrees with the findings of this study. In general, if patients have good results after sleep apnea surgery, those results generally remain unless there is one important change. I tell every patient that weight gain has been the most important factor in loss of benefit that patients experience after sleep apnea surgery. The purpose is not to make anyone feel bad about their body weight or gaining weight in the future, as I am not one to make judgments about anyone. Having a discussion about the importance of body weight is just part of open, honest communication with patients so they understand the limitations of sleep apnea surgery over time.