Effect of targeted multilevel sleep surgery on resistant hypertension in patients with severe obstructive sleep apnea

Objective: Obstructive sleep apnea is an independent risk factor for cardiovascular diseases, particularly resistant hypertension. For patients who are noncompliant or unable to tolerate continuous positive airway pressure therapy, surgical treatment may serve as a viable alternative. In this study, we evaluated the impact of multilevel sleep surgery on blood pressure levels in patients with resistant hypertension. Methods: This is a bicentric retrospective observational study of 50 patients with severe obstructive sleep apnea and resistant hypertension who underwent multilevel targeted sleep surgery. Results: Clinical improvement was objectively confirmed by polygraphy performed 6 months after surgery, demonstrating a significant reduction in the mean Apnea–Hypopnea Index from 44.98 ± 14.94 to 22.16 ± 7.30 (P < 0.005). Furthermore, the adjusted mean preoperative systolic blood pressure decreased from 150 ± 14.77 to 124 ± 17.14 mmHg (P < 0.001), while diastolic blood pressure decreased from 94 ± 5.3 to 80 ± 7.2 mmHg (P < 0.001). Notably, 20 patients (40%) no longer required antihypertensive medication after surgery. Discussion: To the best of our knowledge, this study is the first clinical trial to evaluate the efficacy of multilevel surgery in improving resistant systemic hypertension in patients with multilevel airway obstruction and severe obstructive sleep apnea syndrome. Conclusions: This study highlights the potential of multilevel sleep surgery as an effective intervention for improving blood pressure control in patients with resistant hypertension and severe obstructive sleep apnea.