Physiology-Based Modeling May Predict Surgical Treatment Outcome for Obstructive Sleep Apnea
Open accessAbstract
Study objectives To test whether the integration of both anatomical and nonanatomical parameters (ventilatory control, arousal threshold, muscle responsiveness) in a physiology-based model will improve the ability to predict outcomes after upper airway surgery for obstructive sleep apnea (OSA).Methods In 31 patients who underwent upper airway surgery for OSA, loop gain and arousal threshold were calculated from preoperative polysomnography (PSG). Three models were compared: (1) a multiple regression based on an extensive list of PSG parameters alone; (2) a multivariate regression using PSG parameters plus PSG-derived estimates of loop gain, arousal threshold, and other trait surrogates; (3) a physiological model incorporating selected variables as surrogates of anatomical and nonanatomical traits important for OSA pathogenesis.Results Although preoperative loop gain was positively correlated with postoperative apnea-hypopnea index (AHI) (P = .008) and arousal threshold was negatively correlated (P = .011), in both model 1 and 2, the only significant variable was preoperative AHI, which explained 42% of the variance in postoperative AHI. In contrast, the physiological model (model 3), which included AHI REM (anatomy term), fraction of events that were hypopnea (arousal term), the ratio of AHI REM and AHI NREM (muscle responsiveness term), loop gain, and central/mixed apnea index (control of breathing terms), was able to explain 61% of the variance in postoperative AHI.Conclusions Although loop gain and arousal threshold are associated with residual AHI after surgery, only preoperative AHI was predictive using multivariate regression modeling. Instead, incorporating selected surrogates of physiological traits on the basis of OSA pathophysiology created a model that has more association with actual residual AHI.Commentary A commentary on this article appears in this issue on page 1023.Clinical trial registration ClinicalTrials.Gov; Title: The Impact of Sleep Apnea Treatment on Physiology Traits in Chinese Patients With Obstructive Sleep Apnea; Identifier: NCT02696629; URL: https://clinicaltrials.gov/show/NCT02696629.
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Some data suggest that a low arousal threshold may be a risk factor for failure of upper airway surgery to achieve a surgical cure.
“Some data suggest that a low arousal threshold may be a risk factor for failure of UA surgery to achieve a surgical cure.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [363]
The “Modeling Response to Surgery” section says low arousal threshold was correlated with better surgical outcome, not failure to achieve a cure. The “Baseline Loop Gain, Arousal Threshold and Surgical Outcome” section likewise reports an association with lower postoperative AHI. Page numbers are unavailable in our copy. (LLM, conf=0.91)
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Experimental — accuracy not yet measuredElevated 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 [363]
The section “The Value of Estimates of Nonanatomical Traits for Upper Airway Surgery” says elevated baseline loop gain was associated with poor surgical outcome, and “Baseline Loop Gain, Arousal Threshold and Surgical Outcome” reports a correlation with postoperative AHI. However, the Abstract says only preoperative AHI was predictive in multivariate regression, so the paper does not establish elevated loop gain as an independent predictor of surgical failure. (LLM, conf=0.85)
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References 35 · Cited by 64
- Authors
- Li, Y., Ye, J., Han, D., Cao, X., Ding, X., Zhang, Y., Xu, W., Orr, J., Jen, R., Sands, S., Malhotra, A., & Owens, R.
- Affiliations
- Beijing Tongren Hospital (CN)
- University of California San Diego (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Ye, Jingying
- Han, Demin
- ORCID
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2017-09-15
- Volume
- 13
- Issue
- 9
- Pages
- 1029-1037
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC5566458
- OpenAlex
- W2755823431
- Semantic Scholar
- 01db78fadfb2b58763ee2bc949565bd73abba1f6
- Cited by
- 64
- References
- 35
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 9 · 2023: 4 · 2022: 13 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 5 · 2017: 2
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL134632, R01HL085188, K24HL132105)
- 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, surgical outcome prediction, loop gain, arousal threshold, apnea-hypopnea index, polysomnography, central sleep apnea, hypopnea, OSA pathophysiology, Chinese patients
- MeSH terms
- Adult, China, Female, Humans, Male, Middle Aged, Models, Theoretical, Respiratory System, Retrospective Studies, Cohort Studies, Treatment Outcome, Polysomnography, Sleep Apnea, Obstructive
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