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

Laryngoscope. 2000 Jun;110(6):982-7. doi: 10.1097/00005537-200006000-00019.


Objective: To evaluate the outcomes of airway reconstructive surgery for the treatment of severe obstructive sleep apnea in the morbidly obese patient.

Methods: Retrospective review of consecutively treated patients. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), cephalometric data, and complications.

Results: Twenty-one patients (13 men) with a mean age of 42.6 +/- 7.9 years and mean BMI of 45 +/- 5.4 kg/m2 were identified. The mean RDI improved from 83 +/- 30.1 to 10.6 +/- 10.8 events per hour with an improved 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 BMI at the 6-month postoperative polysomnographic recording was 43 +/- 4.3 kg/m2 (P < .001). Seventeen patients (81%) were successfully treated (RDI < 20 and with minimal desaturation < 90%). The mean follow-up was 21.8 +/- 15.4 months (range, 7-66 mo). Coexisting obesity-hypoventilation syndrome was related to treatment failure in two patients. One patient noted recurrence of daytime fatigue after significant weight gain 4 years after surgery and the polysomnographic recordings demonstrated the recurrence of obstructive sleep apnea.

Conclusion: Airway reconstruction is an effective treatment for severe obstructive sleep apnea in the morbidly obese patient. Careful patient selection and identifying potential coexisting obesity-hypoventilation syndrome, as well as counseling on weight reduction and avoiding continual weight gain will improve treatment outcomes. Key Words: Obstructive sleep apnea, sleep-disordered breathing, obstructive sleep apnea surgery, obesity, maxillomandibular advancement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Airway Obstruction / diagnosis
  • Body Mass Index
  • Cephalometry
  • Female
  • Fiber Optic Technology / methods
  • Humans
  • Male
  • Middle Aged
  • Obesity / complications*
  • Polysomnography
  • Preoperative Care
  • Retrospective Studies
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / etiology
  • Sleep Apnea, Obstructive / surgery*
  • Statistics, Nonparametric
  • Treatment Outcome