Morbidly obese patients with severe obstructive sleep apnea: Is airway reconstructive surgery a viable treatment option?

Objective: To evaluate the outcomes of airway reconstructive surgery for th e treatment of severe obstructive sleep apnea in the morbidly obese patient , Methods: Retrospective review of consecutively treated patients. Variable s examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), cephalometric data, and comp lications. Results: Twenty-one patients (13 men) with a mean age of 42.6 +/ - 7.9 years and mean BMI of 45 +/- 5.4 kg/m(2) were identified. The mean RD I improved from 83 +/- 30.1 to 10.6 +/- 10.8 events per hour with an improv ed mean apnea index from 38.4 +/- 31.3 to 1.2 +/- 1.8 events per hour. The mean LSAT improved from 63.9 +/- 17.7% to 86 +/- 7.9%. The mean BMP at the 6-month postoperative polysomnographic recording was 43 +/- 4.3 kg/m(2) (P < .001). Seventeen patients (81%) were successfully treated (RDI < 20 and w ith minimal desaturation < 90%). The mean follow-up was 21.8 +/- 15.4 month s (range, 7-66 mo). Coexisting obesity-hypoventilation syndrome was related to treatment failure in two patients. One patient noted recurrence of dayt ime fatigue after significant weight gain 4 years after surgery and the pol ysomnographic recordings demonstrated the recurrence of obstructive sleep a pnea. Conclusion: Airway reconstruction is an effective treatment for sever e obstructive sleep apnea in the morbidly obese patient. Careful patient se lection and identifying potential coexisting obesity-hypoventilation syndro me, as web as counseling on weight reduction and avoiding continual weight gain will improve treatment outcomes.