{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T22:27:49Z","timestamp":1759184869624},"reference-count":69,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2014,5,27]],"date-time":"2014-05-27T00:00:00Z","timestamp":1401148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Healthcare remunerating agencies in North America require patients with obstructive sleep apnea (OSA) to undergo a continuous positive airway pressure (CPAP) trial before funding surgical therapy. The adherence rate of CPAP is problematic. This study's objective was to determine the proportion of surgically favorable patients who failed CPAP who subsequently benefitted from surgical therapy, and to explore consideration of surgical therapy as first\u2010line treatment in this specific OSA subpopulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>This was a prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with moderate\u2013severe OSA who had failed a minimum 6\u2010month trial of CPAP were recruited. All had optimal anatomy for surgery and underwent tonsillectomy with palatoplasty\u2009\u00b1\u2009septoplasty. Outcome measures included apnea\u2010hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Quality of Life Index (SAQLI\u2010E), and blood pressure. Patients were followed for 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>By AHI measurement, 85.7% of patients in the entire cohort were successfully treated by surgery. ESS while on CPAP was 13.7\u2009\u00b1\u20092.9, improving to 4.1\u2009\u00b1\u20092.5 after surgery. SAQLI\u2010E scores on CPAP were 25.7\u2009\u00b1\u20095.8, improving to 10.2\u2009\u00b1\u20093.2 after surgery. Blood pressure remained elevated during CPAP but normalized after surgery. All changes were significant at <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surgical intervention improved OSA severity as measured by the ESS, SAQLI\u2010E, and blood pressure. These measures had not improved on CPAP. AHI improved as well. Our results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence and with only minor surgical risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2 <jats:italic>Laryngoscope<\/jats:italic> 124:S1\u2013S9, 2014<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.24720","type":"journal-article","created":{"date-parts":[[2014,4,16]],"date-time":"2014-04-16T10:30:53Z","timestamp":1397644253000},"source":"Crossref","is-referenced-by-count":11,"title":["Redefining the timing of surgery for obstructive sleep apnea in anatomically favorable patients"],"prefix":"10.1002","volume":"124","author":[{"given":"Brian W.","family":"Rotenberg","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna","family":"Theriault","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Gottesman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,5,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2109080"},{"key":"e_1_2_7_3_1","first-page":"1079","article-title":"Sleep apnea as an independent risk factor for all\u2010cause mortality: the Busselton Health Study","volume":"31","author":"Marshall NS","year":"2008","journal-title":"Sleep"},{"key":"e_1_2_7_4_1","unstructured":"Public Health Agency of Canada.Life and breath: respiratory disease in Canada(2007). 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