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In Obstructive Sleep Apnea, Soft-Tissue Surgery Can Improve Cardiometabolic Health Profile

A systematic review and meta-analysis provide an overview of the potential improvements in cardiometabolic health profile, including changes in HDL-C, LDL-C, and triglycerides, observed after patients with obstructive sleep apnea have undergone soft-tissue surgery.

In patients with obstructive sleep apnea, undergoing soft-tissue sleep surgery could contribute to improved inflammatory and cardiometabolic health profiles, according to the result of a new study.

A meta-analysis and systematic review of 26 studies examining the impact of soft-tissue sleep surgery on inflammatory markers in adults with OSA, results of the study suggest undergoing sleep surgery was associated with improvements in C-reactive protein (CRP), glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and interleukin-6 (IL-6).

“Overall, soft-tissue sleep surgery for OSA may be associated with improved cardiometabolic and systemic inflammatory markers. Hence, the findings from this study suggest that the association of sleep surgery with lower levels of inflammatory markers may offer improved outcomes for patients with OSA,” wrote investigators.

Although many had hypothesized the detrimental impact of OSA on cardiometabolic health profiles, it has not been until recently that this impact and potential avenues for mitigation have become a topic of interest for both researchers and clinicians. With this in mind, a team led by investigators representing Singapore General Hospital and Tel Aviv University designed the current study as a systematic review and meta-analysis of data from the Cochrane Embase, and PubMed databases to assess associations between undergoing sleep surgery and proinflammatory markers in patients with OSA.

For the study, investigators sought to identify full-text studies published in English in peer-reviewed journals from inception of the databases to June 14, 2022, that reported preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery. Investigators’ initial search yielded 3218 articles. After application of inclusion criteria and exclusion of duplicates, 56 were selected for full-text review and 26 were ultimately identified for inclusion in the investigators’ meta-analyses.

This group of studies included 17 prospective cohort studies and 9 retrospective cohort studies, with a total population of 1187 patients. The overall patient population had a mean age of 42.8 (SD, 11.1) years, 78.5% were men, and the mean follow-up time was 7.3 (SD, 8.2) months. Investigators pointed out the mean BMI was 28.4 (SD, 2.0) kg/m2, mean AHI was 36.0 (SD, 13.8), mean ESS was 11.2 (SD, 2.3), the cumulative sleep time percentage with oxyhemoglobin saturation less than 90% (CT90) was 16.7 (SD, 8.7), and the mean arterial oxygen saturation (SaO2) nadir was 73.3% (SD, 13.2%).

The primary outcome of interest was the preoperative and postoperative levels of multiple serum biomarkers in patients. For the purpose of analysis, meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models and, investigators pointed out, the probability of benefit and number needed to treat were calculated for outcomes that demonstrated a statistically significant effect after sleep surgery to ensure relevance to clinicians and patients.

Results of the investigators’ analyses indicated undergoing soft-tissue sleep surgery was associated with a large decrease in CRP (SMD, -0.377 [95% CI, -0.617 to -0.137), total cholesterol (SMD, -0.267 [95% CI, -0.417 to -0.116), LDL (SMD, -0.201 [95% CI, -0.344 to -0.058), IL-6 (SMD, -1.086 [95% CI, -1.952 to -0.221]), tumor necrosis factor-α (SMD, -0.822 [95% CI, -1.617 to -0.027]), triglyceride (SMD, -0.186 [95% CI, -0.301 to -0.071]), and leptin (SMD, -0.519 [95% CI, -0.954 to -0.083]) in patients with OSA. Meta-regression revealed increased age, greater preoperative CT90, and greater change in CT90 postoperatively were associated with a greater decrease in serum CRP levels. Investigators also highlighted a greater reduction in AHI was associated with a greater reduction in total and LDL cholesterol, while greater reductions in BMI and AHI were also associated with a greater increase in HDL cholesterol.

“In this pairwise meta-analysis of 26 studies, we demonstrated that sleep surgery was associated with a large decrease in serum CRP, total cholesterol, LDL, IL-6, TNF-α, triglyceride, and leptin. This reduction remained across different types of surgeries, geographic regions, follow-up duration, and hs-CRP vs CRP subgroups,” investigators added.

This study, “Improved Inflammatory and Cardiometabolic Profile After Soft-Tissue Sleep Surgery for Obstructive Sleep Apnea,” was published in JAMA Otolaryngology–Head & Neck Surgery.