• Yanru Li, Jingying Ye, Demin Han, Di Zhao, Xin Cao, Jeremy Orr, Rachel Jen, Naomi Deacon-Diaz, Scott A Sands, Robert Owens, and Atul Malhotra.
• Department of Otolaryngology Head and Neck Surgery and Clinical Center for OSAHS, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
• J Clin Sleep Med. 2019 Jun 15; 15 (6): 907-913.

Study ObjectivesControversy exists as to whether elevated loop gain is a cause or consequence of obstructive sleep apnea (OSA). Upper airway surgery is commonly performed in Asian patients with OSA who have failed positive airway pressure therapy and who are thought to have anatomical predisposition to OSA. We hypothesized that high loop gain would decrease following surgical treatment of OSA due to reduced sleep apnea severity.MethodsPolysomnography was performed preoperatively and postoperatively to assess OSA severity in 30 Chinese participants who underwent upper airway surgery. Loop gain was calculated using a validated clinically-applicable method by fitting a feedback control model to airflow.ResultsPatients were followed up for a median (interquartile range) of 130 (62, 224) days after surgery. Apnea-hypopnea index (AHI) changed from 60.8 (33.7, 71.7) to 18.4 (9.9, 42.5) events/h (P < .001). Preoperative and postoperative loop gain was 0.70 (0.58, 0.80) and 0.53 (0.46, 0.63) respectively (P < .001). There was a positive association between the decrease in loop gain and the improvement of AHI (P = .025).ConclusionsHigh loop gain was reduced by surgical treatment of OSA in our cohort. These data suggest that elevated loop gain may be acquired in OSA and may provide mechanistic insight into improvement in OSA with upper airway surgery.Clinical Trial RegistrationRegistry: 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.© 2019 American Academy of Sleep Medicine.

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