Patient Factors and Preferences in Choosing Sleep Surgery for Obstructive Sleep Apnea: A Qualitative Study

Allison K Ikeda; Crystina McShay; Robin Marsh; Shireen Saini; Maya G Sardesai; Edward M Weaver; Emily F Boss

doi:10.1177/01945998221105404

Patient Factors and Preferences in Choosing Sleep Surgery for Obstructive Sleep Apnea: A Qualitative Study

Otolaryngol Head Neck Surg. 2023 Mar;168(3):514-520. doi: 10.1177/01945998221105404. Epub 2023 Jan 19.

Authors

Allison K Ikeda¹, Crystina McShay², Robin Marsh², Shireen Saini², Maya G Sardesai¹, Edward M Weaver¹, Emily F Boss³

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
² Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.

PMID: 35671145
DOI: 10.1177/01945998221105404

Abstract

Objective: There are several obstructive sleep apnea (OSA) treatment options available to patients, including surgery and less invasive therapies. Little is known about the factors that influence patient preferences for treatment. We aimed to understand factors influencing patient experience and decision making for undergoing sleep surgery.

Study design: Retrospective qualitative study.

Setting: Tertiary sleep surgery clinic.

Methods: We conducted semistructured interviews with adults who previously underwent any nasal and/or pharyngeal sleep surgery. We asked open-ended questions about their decision-making process within a preconceived thematic framework of chief OSA symptoms, expectations for recovery, and sources of information. The interviews were audio recorded and transcribed, and content was analyzed for defined, emergent, and prevalent themes.

Results: Ten patients were interviewed from December 11, 2020 through January 29, 2021. Six patients underwent nasal surgery, 1 underwent pharyngeal surgery, and 3 underwent staged nasal and pharyngeal procedures. All patients were beyond the acute recovery phase. Reasons for pursuing surgical consultation varied from sleep apnea burden to external factors, such as recommendations from significant others. Duration of sleep surgery consideration varied from months to years. Major concerns about sleep surgery involved anesthesia and postoperative pain. External factors influencing patients' decisions to pursue sleep surgery included family and friend support. Postoperative outcomes of surgery included patient satisfaction with decision for surgery, given OSA improvements.

Conclusion: Understanding patient factors that influence decision making for sleep surgery may guide clinicians in patient-centered counseling that engages patients in decision making, aligning with clinical symptoms and patient preferences.

Keywords: obstructive sleep apnea; patient preferences; qualitative methods; shared decision making; sleep surgery.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Adult
Humans
Pharynx / surgery
Retrospective Studies
Sleep
Sleep Apnea Syndromes*
Sleep Apnea, Obstructive* / diagnosis