Uvulopalatopharyngoplasty may reduce cardiac risk in sleep apnea

Surgical remodeling of the tissues of the throat using uvulopalatopharyngoplasty (UPPP) could significantly reduce the cardiac complications of obstructive sleep apnea (OSA), according to a study published in Sleep Medicine.

Researchers examined the incidence of newly diagnosed myocardial infarction, congestive heart failure, and atrial fibrillation in 192,316 patients with a new diagnosis of obstructive sleep apnea – 22,213 of whom had undergone UPPP – and 961,590 controls.

The individuals who had had UPPP had a significantly lower incidence of all three cardiovascular events, compared with those who had not undergone the procedure. The hazard ratios for myocardial infarction, congestive heart failure, and atrial fibrillation among individuals with OSA who had uvulopalatopharyngoplasty, compared with controls, were 1.002, 0.757 and 1.117, respectively. By comparison, those hazard ratios in patients with OSA who had not had UPPP, compared with controls, were 1.070, 1.165, and 1.39 for myocardial infarction, congestive heart failure, and atrial fibrillation respectively.

These figures were after accounting for confounding factors, such as age, sex, diabetes, hypertension, and dyslipidemia.

The authors wrote that the most distinctive finding of their study was that uvulopalatopharyngoplasty lowered the incidence of congestive heart failure and atrial fibrillation in patients with obstructive sleep apnea to the point that they had the same level of risk as individuals without obstructive sleep apnea.

“Prior studies have evaluated the success of UPPP based on reductions of AHI [apnea-hypopnea index], with the average success rate for the surgery being low for most patients,” wrote Heung-Man Lee, MD, PhD, then from the Guro Hospital at Korea University, Seoul, and his coauthors.

“However, the current study suggests that the effects of UPPP, regardless of the effects on AHI, can significantly reduce cardiac morbidity in patients with OSA.”

Patients without diabetes showed more benefit from UPPP in reducing the incidence of congestive heart failure, compared with those with diabetes. However, those with diabetes showed greater reductions in the risk of atrial fibrillation, compared with those without diabetes.

Similarly, the incidence of atrial fibrillation was reduced after uvulopalatopharyngoplasty but only in patients with hypertension or dyslipidemia and not in those with normal blood pressure or lipid levels.

“These differences in outcomes after UPPP are probably due to the different etiologies of cardiovascular disease,” the authors wrote. “OSA increases free fatty acid in the blood because intermittent hypoxia associated with OSA induces adipose tissue lipolysis.”

One limitation of the study was the absence of polysomnography information. The researchers relied on diagnostic codes for confirmation of OSA. They also did not have information on other sleep apnea therapies, such as CPAP or a mandibular advancing device, which may have been used in the patients who did not undergo uvulopalatopharyngoplasty.

The study was supported by the Korean Society of Otorhinolaryngology Head and Neck Surgery. No conflicts of interest were declared.

SOURCE: Lee HM et al. Sleep Med. 2018 May;45:11-16.
 

Surgical remodeling of the tissues of the throat using uvulopalatopharyngoplasty (UPPP) could significantly reduce the cardiac complications of obstructive sleep apnea (OSA), according to a study published in Sleep Medicine.

Researchers examined the incidence of newly diagnosed myocardial infarction, congestive heart failure, and atrial fibrillation in 192,316 patients with a new diagnosis of obstructive sleep apnea – 22,213 of whom had undergone UPPP – and 961,590 controls.

The individuals who had had UPPP had a significantly lower incidence of all three cardiovascular events, compared with those who had not undergone the procedure. The hazard ratios for myocardial infarction, congestive heart failure, and atrial fibrillation among individuals with OSA who had uvulopalatopharyngoplasty, compared with controls, were 1.002, 0.757 and 1.117, respectively. By comparison, those hazard ratios in patients with OSA who had not had UPPP, compared with controls, were 1.070, 1.165, and 1.39 for myocardial infarction, congestive heart failure, and atrial fibrillation respectively.

These figures were after accounting for confounding factors, such as age, sex, diabetes, hypertension, and dyslipidemia.

The authors wrote that the most distinctive finding of their study was that uvulopalatopharyngoplasty lowered the incidence of congestive heart failure and atrial fibrillation in patients with obstructive sleep apnea to the point that they had the same level of risk as individuals without obstructive sleep apnea.

“Prior studies have evaluated the success of UPPP based on reductions of AHI [apnea-hypopnea index], with the average success rate for the surgery being low for most patients,” wrote Heung-Man Lee, MD, PhD, then from the Guro Hospital at Korea University, Seoul, and his coauthors.

“However, the current study suggests that the effects of UPPP, regardless of the effects on AHI, can significantly reduce cardiac morbidity in patients with OSA.”

Patients without diabetes showed more benefit from UPPP in reducing the incidence of congestive heart failure, compared with those with diabetes. However, those with diabetes showed greater reductions in the risk of atrial fibrillation, compared with those without diabetes.

Similarly, the incidence of atrial fibrillation was reduced after uvulopalatopharyngoplasty but only in patients with hypertension or dyslipidemia and not in those with normal blood pressure or lipid levels.

“These differences in outcomes after UPPP are probably due to the different etiologies of cardiovascular disease,” the authors wrote. “OSA increases free fatty acid in the blood because intermittent hypoxia associated with OSA induces adipose tissue lipolysis.”

One limitation of the study was the absence of polysomnography information. The researchers relied on diagnostic codes for confirmation of OSA. They also did not have information on other sleep apnea therapies, such as CPAP or a mandibular advancing device, which may have been used in the patients who did not undergo uvulopalatopharyngoplasty.

The study was supported by the Korean Society of Otorhinolaryngology Head and Neck Surgery. No conflicts of interest were declared.

SOURCE: Lee HM et al. Sleep Med. 2018 May;45:11-16.
 

Surgical remodeling of the tissues of the throat using uvulopalatopharyngoplasty (UPPP) could significantly reduce the cardiac complications of obstructive sleep apnea (OSA), according to a study published in Sleep Medicine.

Researchers examined the incidence of newly diagnosed myocardial infarction, congestive heart failure, and atrial fibrillation in 192,316 patients with a new diagnosis of obstructive sleep apnea – 22,213 of whom had undergone UPPP – and 961,590 controls.

The individuals who had had UPPP had a significantly lower incidence of all three cardiovascular events, compared with those who had not undergone the procedure. The hazard ratios for myocardial infarction, congestive heart failure, and atrial fibrillation among individuals with OSA who had uvulopalatopharyngoplasty, compared with controls, were 1.002, 0.757 and 1.117, respectively. By comparison, those hazard ratios in patients with OSA who had not had UPPP, compared with controls, were 1.070, 1.165, and 1.39 for myocardial infarction, congestive heart failure, and atrial fibrillation respectively.

These figures were after accounting for confounding factors, such as age, sex, diabetes, hypertension, and dyslipidemia.

The authors wrote that the most distinctive finding of their study was that uvulopalatopharyngoplasty lowered the incidence of congestive heart failure and atrial fibrillation in patients with obstructive sleep apnea to the point that they had the same level of risk as individuals without obstructive sleep apnea.

“Prior studies have evaluated the success of UPPP based on reductions of AHI [apnea-hypopnea index], with the average success rate for the surgery being low for most patients,” wrote Heung-Man Lee, MD, PhD, then from the Guro Hospital at Korea University, Seoul, and his coauthors.

“However, the current study suggests that the effects of UPPP, regardless of the effects on AHI, can significantly reduce cardiac morbidity in patients with OSA.”

Patients without diabetes showed more benefit from UPPP in reducing the incidence of congestive heart failure, compared with those with diabetes. However, those with diabetes showed greater reductions in the risk of atrial fibrillation, compared with those without diabetes.

Similarly, the incidence of atrial fibrillation was reduced after uvulopalatopharyngoplasty but only in patients with hypertension or dyslipidemia and not in those with normal blood pressure or lipid levels.

“These differences in outcomes after UPPP are probably due to the different etiologies of cardiovascular disease,” the authors wrote. “OSA increases free fatty acid in the blood because intermittent hypoxia associated with OSA induces adipose tissue lipolysis.”

One limitation of the study was the absence of polysomnography information. The researchers relied on diagnostic codes for confirmation of OSA. They also did not have information on other sleep apnea therapies, such as CPAP or a mandibular advancing device, which may have been used in the patients who did not undergo uvulopalatopharyngoplasty.

The study was supported by the Korean Society of Otorhinolaryngology Head and Neck Surgery. No conflicts of interest were declared.

SOURCE: Lee HM et al. Sleep Med. 2018 May;45:11-16.