TABLE IX.E.5.

Evidence for surgery and cardiovascular markers and outcomes

Study	Year	LOE	Study design	Study groups	Clinical end-point	Conclusion
Halle et al.1687	2017	2a	Systematic review of cohort studies and case series	Multiple studies on different surgical interventions	Nineteen different cardiovascular endpoints assessed	Data is limited secondary to weak study design (level 4 evidence) but surgery showed improvements in CV outcomes.
Lee et al.1964	2018	2b	Cohort study	170,103 patients with OSA (no surgery), 22, 213 with OSA and had UPPP; propensity score matched controls: 961,590 no OSA	Newly diagnosed MI, CHF, and AF	UPPP was associated with lower incidences of CHF and AF. MI incidence rate was not significant.
Zhan et al.1965	2019	4	Case series	53 patients that underwent UPPP surgery	CIMT, arterial stiffness, echocardiography, and PSG	ST surgery improves parameters associated with carotid arteriosclerosis.
Chin et al.2038	2019	4	Case series	89 patients that underwent multilevel ST surgery	Serum leptin, cholesterol, SBP, DBP, and triglycerides	Cardiovascular markers such as total cholesterol, triglycerides, and leptin improved with successful surgery.
Dedhia et al.1898	2019	4	Case series	33 patients with UAS device	Nocturnal heart rate variability	Pts with UAS had reduced nocturnal heart rate variability.
Suslu et al.1705	2017	4	Case series	28 patients that underwent lateral expansion pharyngoplasty	Nocturnal heart rate variability	Autonomic variables included HRV were decreased in the patients who achieved surgical success.
Binar et al.1693	2017	3b	Case–control study	23 patients that underwent lateral expansion pharyngoplasty vs. 28 patients on CPAP	hs-CRP, AHI, ESS	Only surgical patients that had AHI <5 after surgery had significant hs-CRP reductions.
Peng et al.2045	2016	3b	Case–control study	52 patients underwent nasal surgery and UPPP, 12 had CPAP only	AHI, ESS, CIMT cholesterol	Six months after surgery significant changes in CIMT and with successful surgery.
Lin et al.2046	2014	3b	Case–control study	15 healthy patients compared to 35 OSA pts undergoing UPPP	AHI, serum leptin, NOx	Patients with surgical success had normalization in leptin and NOx.
Choi et al.2043	2012	3b	Case–control study	14 patients with unsuccessful ST surgery and 22 pts with successful ST surgery	BMI, PSG data, HRV	HRV significantly decreased in the successful surgical group.
Lee et al.2042	2011	4	Case series	30 patients underwent lateral expansion pharyngoplasty	BMI, ESS, AHI, and hs-CRP before and 6 months after surgery	Significant reductions in hs-CRP was noted regardless of AHI reduction.
Kinoshita et al.2047	2006	4	Case series	15 patients that underwent UPPP surgery	BMI, AHI, cholesterol, BP, and CRP	Significant reduction in CRP seen.
Zoha et al.2048	1992	4	Case series	19 patients undergoing UPPP surgery	AHI, left and right ventricular EF	91% of patient had global improvements in EF.
Partinen et al.2049	1990	3b	Case series–control study	71 patients that underwent tracheostomy vs. 127 recommended weight loss	Stroke, MI, CAD, Mortality, BP	Significant differences in mortality and cardiovascular events at 7 years of follow-up.

Abbreviations: AF, atrial fibrillation; AHI, apnea/hypopnea index; BMI, body mass index; BP, blood pressure; CAD, coronary artery disease; CHF, congestive heart failure; CIMT, carotid intima-media thickness; CRP, C reactive protein; EF, ejection fraction; ESS, Epworth Sleepiness Scale; HRV, heart rate variability; hs-CRP, high sensitive c-reactive protein; MI, myocardial infarction; NOx, nitric oxide derivative; PSG, polysomnography; ST, soft tissue; UAS, upper airway stimulator; UPPP, uvulopalatopharyngoplasty.