ACDF Impact on Aerodigestive Function and Obstructive Sleep Apnea: A Scoping Review

Anterior cervical discectomy and fusion (ACDF) treats cervical disc herniation, cervical spondylosis, and spinal stenosis. Post-operative complications may include dysphagia, pharyngeal edema, and muscle weakness. Recent studies have examined the interplay between ACDF and obstructive sleep apnea (OSA). This scoping review aimed to: (1) explore whether ACDF increases the risk of OSA onset or worsening; (2) summarize reported ACDF-OSA outcomes; and (3) identify gaps to inform future research and clinical practices.

PubMed, MEDLINE via Ovid, CINAHL, Cochrane, Scopus, Web of Science, and Google Scholar.

Following PRISMA-ScR guidelines, English-language studies of adults with pre- or postoperative OSA after ACDF were included; eligibility was independently assessed by two reviewers with consensus resolution.

Twelve of 619 studies met the inclusion criteria, reporting both new-onset and worsening of pre-existing OSA following ACDF. Patients with pre-existing or newly diagnosed OSA demonstrated increased 144post-operative respiratory complications and healthcare utilization, including a greater need for mechanical ventilation and longer hospital length of stay; dysphagia occurred in both groups. Proposed contributors to post-ACDF OSA included pharyngeal narrowing, altered cervical alignment, edema, hardware-related airway compromise, and post-operative weight gain. The reviewed studies provided little to no information on perioperative OSA management, including the use or effectiveness of positive airway pressure therapy.

ACDF may be associated with structural, neuromuscular, and functional changes that increase the risk of OSA onset or severity. Prospective studies using validated measures are needed to determine whether interdisciplinary approaches, including OSA screening and individualized perioperative care, improve ACDF outcomes.

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