Association of upper airway surgery and improved cardiovascular biomarkers and risk in OSA.

Abstract

To evaluate the association between upper airway surgery and changes of cardiological metabolic biomarkers and the overall cardiovascular risk in obstructive sleep apnea (OSA), and to define factors associated with better cardiovascular outcomes. A total of 161 patients with newly diagnosed OSA who underwent classical or modified uvulopalatopharyngoplasty with or without genioglossus advancement and hyoid suspension were included. The pre- and postoperative (at least 6 months later) assessments, including polysomnography, measurement of glucose and lipids, blood pressure, and overall cardiovascular risk (as estimated by Framingham Risk Scores), were compared. We accounted for multiple comparisons with the use of the Benjamini-Hochberg correction. The mean follow-up time was 2.5 ± 1.9 years. The apnea hypopnea index decreased significantly in the entire cohort (mean changes with 95% confidence intervals were [-25.3 (-29.5, -21.0) events/hour, P < 0.001]. We also noted decreases in the age-adjusted Framingham Risk Scores [-2.5% (-4.0%, -1.0%), P < 0.001] as well as single cardiometabolic biomarkers, including glucose [-0.50 (-0.70, -0.30) mmol/L, P < 0.001], total cholesterol [-0.46 (-0.65, -0.28) mmol/L, P < 0.001], triglycerides [-0.56, (-0.99, -0.14) mmol/L, P = 0.014], low-density lipoprotein cholesterol [-0.27, (-0.43, -0.11) mmol/L, P = 0.002], apolipoprotein B [-0.10 (-0.14, -0.07) g/L, P < 0.001], systolic blood pressure [-3.58 (-6.02, -1.14) mmHg, P = 0.007], and diastolic blood pressure [-3.25 (-5.47, -1.02) mmHg, P = 0.008] after surgery. Patients with preoperative metabolic abnormalities exhibited better postoperative risk profiles changes (P < 0.001). In addition, associations were found between Δapolipoprotein B, Δsystolic blood pressure, and improvements in nocturnal oxygen level after surgery. OSA-related upper airway surgery was associated with improvements in cardiological metabolic biomarker levels and the overall cardiovascular risk, especially in patients with both OSA and metabolic disorders. The changes in biomarker levels may be associated with improved oxygen saturation after surgery. 4 Laryngoscope, 130:818-824, 2020.