0597 SURGICAL TREATMENT OF OBSTRUCTIVE SLEEP APNEA ON CARDIOVASCULAR OUTCOMES: A SYSTEMATIC REVIEW

Abstract

Introduction: Obstructive sleep apnea (OSA) is an increasingly prevalent clinical problem with significant effects on both personal and public health. Continuous positive airway pressure (CPAP) has demonstrated strong efficacy and low morbidity; however, longterm adherence rates approach 50%. Various surgical therapies are available for treatment of OSA. The effectiveness of these therapies is generally measured by polysomnographic and subjective variables; however, these outcome measures do not necessarily correlate with cardiovascular parameters. This systematic review examines the available cardiovascular data in the setting of surgical treatment of OSA. Method(s): A comprehensive search of the literature was performed using the databases of PubMed, Embase, SCOPUS, the Cochrane Library, BioMed Central, and Web of Science from inception to July 2016. Articles were included if they met the following criteria: (1) The sample population consisted of adults (age >=18 years); (2) OSA was diagnosed by polysomnogram; (3) surgical intervention was performed for OSA; (4) subjects served as their own controls (pre-treatment vs. post-treatment) or were compared to a separate control group; (5) one or more physical or biochemical cardiovascular and/or cerebrovascular variables was measured pre-operatively and at >=14 days post-operatively. Result(s): Thirty-six articles were included with total subjects equaling 13,650. The majority of studies were case-series and cohort study design (42% and 44%, respectively) with a wide-ranging follow-up period (15 days-9 years). The following surgical interventions were examined: pharyngeal surgery (n=22), tracheostomy (n=10), maxillomandibular advancement (n=3), hypoglossal nerve stimulation (n=1). Nine studies examined blood pressure as the primary cardiovascular outcome with improvement (n=8), no change (n=1). Surgical treatment also showed positive effects on cerebrovascular accident rate, mortality, heart rate variability, flow-mediated dilation, C-reactive protein levels, intimal carotid artery thickness, cardiac arrhythmia, ejection fraction, pulmonary artery pressure, adiponectin and leptin. Conclusion(s): Current data suggest that surgical treatment of obstructive sleep apnea provides improvement in a diverse set of cardiovascular endpoints. As the majority of studies represent low-level evidence, larger, prospective studies with more rigorous study design are required.