Loop Gain Predicts the Response to Upper Airway Surgery in Patients With Obstructive Sleep Apnea
Open accessAbstract
Study Objectives: Upper airway surgery is often recommended to treat patients with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airways pressure. However, the response to surgery is variable, potentially because it does not improve the nonanatomical factors (ie, loop gain [LG] and arousal threshold) causing OSA. Measuring these traits clinically might predict responses to surgery. Our primary objective was to test the value of LG and arousal threshold to predict surgical success defined as 50% reduction in apnea-hypopnea index (AHI) and AHI <10 events/hour post surgery. Methods: We retrospectively analyzed data from patients who underwent upper airway surgery for OSA (n = 46). Clinical estimates of LG and arousal threshold were calculated from routine polysomnographic recordings presurgery and postsurgery (median of 124 [91-170] days follow-up). Results: Surgery reduced both the AHI (39.1 ± 4.2 vs. 26.5 ± 3.6 events/hour; p < .005) and estimated arousal threshold (-14.8 [-22.9 to -10.2] vs. -9.4 [-14.5 to -6.0] cmH2O) but did not alter LG (0.45 ± 0.08 vs. 0.45 ± 0.12; p = .278). Responders to surgery had a lower baseline LG (0.38 ± 0.02 vs. 0.48 ± 0.01, p < .05) and were younger (31.0 [27.3-42.5] vs. 43.0 [33.0-55.3] years, p < .05) than nonresponders. Lower LG remained a significant predictor of surgical success after controlling for covariates (logistic regression p = .018; receiver operating characteristic area under curve = 0.80). Conclusions: Our study provides proof-of-principle that upper airway surgery most effectively resolves OSA in patients with lower LG. Predicting the failure of surgical treatment, consequent to less stable ventilatory control (elevated LG), can be achieved in the clinic and may facilitate avoidance of surgical failures.
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Elevated loop gain has been found to predict failure of sleep apnea surgeries, at least in some cases.
“From a surgical perspective, elevated loop gain may be important since it has been found to predict failure of sleep apnea surgeries, at least in some cases.363–365”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [365]
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- Authors
- Joosten, S. A., Leong, P., Landry, S. A., Sands, S. A., Terrill, P. I., Mann, D., Turton, A., Rangaswamy, J., Andara, C., Burgess, G., Mansfield, D., Hamilton, G. S., & Edwards, B. A.
- Affiliations
- Monash Medical Centre (AU)
- Monash University (AU)
- Brigham and Women's Hospital (US)
- The University of Queensland (AU)
- Monash Health (AU)
- Corresponding author
- Joosten, Simon A.
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-05-22
- Volume
- 40
- Issue
- 7
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W2617097908
- Semantic Scholar
- ac405c996f57616b04118c08b6a82d10431563cf
- Cited by
- 139
- References
- 36
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 11 · 2023: 13 · 2022: 11 · 2021: 20 · 2020: 20 · 2019: 34 · 2018: 13 · 2017: 2
- FWCI
- 13.96
- Type
- journal article
- Language
- en
- Open access
- green
- research.monash.edu
- Licence
- other-oa
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- Funders
- American Heart Association (15SDG25890059)
- American Thoracic Society
- Medical Research Council
- National Health and Medical Research Council (1064163, 1035115, 1053201)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, upper airway surgery, loop gain, arousal threshold, apnea-hypopnea index, ventilation control, polysomnography, surgical failure
- MeSH terms
- Adult, Arousal, Female, Humans, Male, Middle Aged, Prognosis, Respiratory System, Retrospective Studies, Treatment Outcome, Polysomnography, Sleep Apnea, Obstructive
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