CSSC Mornington

Results of sleep apnea surgery 2019-2021

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At CSSC, we assess patients before and after surgery with a 1) sleep study, 2) endoscopic gardening of the airway 3) symptomatic score called ESS.

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We analysed the results of over 40 operated patients (who declined CPAP) between 2019-2021. When assessed by a sleep study, success is defined as a fifty per cent reduction in apnoea events and lowering the AHI number below 20 events an hour. If using the above definition, our modern surgery has achieved over 80% success rate for some with the most challenging anatomy noted in published literature. Rest of the patients were CPAP compliant. Due to combination of medical and surgical options, over 85% of the patients seen at CSSC have found suitable solution for their sleep apnoea. 

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We noted some of those who felt better did not always show a correlating reduction in apnoea events in their sleep study. The lack of correlation was due to various reasons. At times, the patients tended to sleep more on their backs after surgery (where apnoeas are worse), as they felt their airway was more open. Further, some slept more in REM or DREAM sleep after surgery, where sleep apnoea occurs the most. In one patient, baseline oxygen level improved so much (to 97%) that even their lowest dip to 91% was considered a "hypopnea event" in their open operative sleep study. Before surgery, their oxygen was consistently lower but had lesser recorded dips. There were two other patients who failed to show any improvement in their sleep score, despite clinical improvement. Both of them will be trialling a 3D printed mouthguard as an adjunct treatment. They were unable to tolerate a CPAP machine preoperatively but are likely to succeed with combination therapy.

 

Over 85% of the patients coming to CSSC successfully solved their sleep apnoea with Sleep Apnea Surgery, CPAP or combination therapy. 15% were either lost to follow up or was unwilling to use recommended treatment. 

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Traditionally difficult-Freedman III stage is no longer is a barrier for sleep apnoea surgery. However, not every single patient have had a suitable solution. Note that these results relate to the audit period from 2019-2021. We are working on a new index to predict outcomes better. The above data was presented at the Australian Conference (ASOHNS) in 2020 and 2021. We hope to publish this data in 2022.