Composite Outcomes of Sleep Surgery Using the Modified Sleep Apnea Severity Index (mSASI)

Area of Science:

• Sleep Medicine
• Otolaryngology
• Surgical Outcomes

Background:

• The apnea-hypopnea index (AHI) has limitations in capturing the full spectrum of obstructive sleep apnea (OSA) disease burden.
• The modified sleep apnea severity index (mSASI) provides a composite measure of OSA severity, integrating anatomical, physiological, and symptomatic factors.
• The utility of mSASI in patients intolerant to continuous positive airway pressure (CPAPi) undergoing surgery is not well-established.

Purpose of the Study:

• To evaluate the modified sleep apnea severity index (mSASI) as a tool for assessing preoperative OSA severity.
• To characterize surgical outcomes in CPAP-intolerant patients using the mSASI.
• To explore the association between mSASI and treatment efficacy following upper airway surgery.

Main Methods:

• Retrospective cohort study of 260 CPAP-intolerant patients who underwent upper airway stimulation (UAS), maxillomandibular advancement (MMA), or expansion sphincter pharyngoplasty (ESP).
• Calculation of mSASI scores pre- and postoperatively using a published method.
• Statistical analysis using Wilcoxon rank-sum tests to compare mSASI changes across surgical groups.

Main Results:

• The overall average change in mSASI postoperatively was -0.32 (p < .01).
• mSASI changes varied by surgical procedure: -0.21 for UAS, -0.51 for ESP, and -0.50 for MMA.
• No significant association was found between mSASI score changes and treatment efficacy per Sher's Criteria (p = .6).

Conclusions:

• The mSASI is a valuable index for quantifying preoperative OSA severity in surgical patients.
• mSASI can effectively characterize surgical outcomes in CPAP-intolerant individuals.
• Further prospective research is warranted to validate these findings and assess mSASI's role in detecting post-treatment risk reduction.