Ebrahim Mahmoud, Hussain Salman, Al-Bader Mohammed, Abdulateef Hiba, AlSihan Mutlaq, de Vries Nico, AlTerki Abdulmohsen
Department of Otolaryngology-Head and Neck Surgery, McGill, Montreal, Canada.
Department of Otolaryngology-Head and Neck Surgery, Zain Hospital, Kuwait City, Kuwait.
Eur Arch Otorhinolaryngol. 2025 May;282(5):2641-2648. doi: 10.1007/s00405-025-09208-z. Epub 2025 Jan 20.
Obesity is a major risk factor in Obstructive sleep apnea (OSA), which is a prevalent disease that leads to significant morbidity. Multi-level Sleep Surgery (MLS) is a method of treatment for patients who cannot tolerate continuous positive airway pressure. Obesity has previously been identified as a risk factor that may decrease the success rate of MLS. The purpose of our study is to assess the success rates of MLS in obese patients.
A retrospective cohort study in 109 adults that underwent MLS in our institution. All the participants completed pre-operative and post-operative level 1 polysomnography. They were divided into four groups as per their body mass index (BMI): Normal (BMI < 25), overweight (25-30), obese (30-35), morbid obese (> 35) and the variables were compared. We measured the surgical success as defined by Sher Criteria (AHI drop > 50% from preoperative baseline and AHI < 20) and cure rates (AHI < 5).
The average BMI was 30.9 pre-op and 30.4 post-op. The mean AHI was 29.8 pre-op and decreased to 10.1 (p < 0.001) and the Epworth Sleepiness Scale from 12.9 to 4.8 (p < 0.001). There were 13, 31, 43, and 22 patients in normal, overweight, obese and morbidly obese groups, respectively. The surgical success rate as defined by Sher's criteria was 84%, 84%, 72%, and 77% in the respective groups, with no statistical difference (p = 0.662). Moreover, the cure rate was 77%, 45%, 44%, and 45%, with no statistical difference (p = 0.192). The AHI reduction was 9.93, 19.73, 21.1 and 22.8 in the respective groups. A linear regression analysis revealed no significant difference in assessing the surgical success and cure rates as BMI increases.
Data regarding MLS success rates on obese patients is scarce. The current study demonstrates that MLS can offer positive outcomes for this population. However, further studies are warranted to investigate this relationship.
肥胖是阻塞性睡眠呼吸暂停（OSA）的主要风险因素，OSA是一种常见疾病，会导致严重的发病率。多级睡眠手术（MLS）是一种治疗无法耐受持续气道正压通气的患者的方法。肥胖此前已被确定为可能降低MLS成功率的风险因素。我们研究的目的是评估MLS在肥胖患者中的成功率。
对在我们机构接受MLS的109名成年人进行回顾性队列研究。所有参与者均完成术前和术后一级多导睡眠图检查。根据他们的体重指数（BMI）将他们分为四组：正常（BMI＜25）、超重（25-30）、肥胖（30-35）、病态肥胖（＞35），并对变量进行比较。我们根据Sher标准（AHI较术前基线下降＞50%且AHI＜20）定义手术成功率，并计算治愈率（AHI＜5）。
术前平均BMI为30.9，术后为30.4。术前平均AHI为29.8，术后降至10.1（p＜0.001），Epworth嗜睡量表评分从12.9降至4.8（p＜0.001）。正常、超重、肥胖和病态肥胖组分别有13、31、43和22名患者。根据Sher标准定义的手术成功率在各组中分别为84%、84%、72%和77%，无统计学差异（p = 0.662）。此外，治愈率分别为77%、45%、44%和45%，无统计学差异（p = 0.192）。各组的AHI降低值分别为9.93、19.73、21.1和22.8。线性回归分析显示，随着BMI增加，评估手术成功率和治愈率无显著差异。
关于MLS在肥胖患者中成功率的数据很少。当前研究表明，MLS可为该人群带来积极结果。然而，需要进一步研究来调查这种关系。
