Endotypic Traits and Obstructive Sleep Apnea Surgery

Inclusion Criteria

• •1. age ≥21 years;
• •2. moderate to severe OSA (obstructive AHI ≥ 15 events/hour);
• •3. central/mixed apnea index \<5 events/hour;
• •4. intolerance of positive airway pressure (defined as use \< 2 hours/night at least 5 nights/week);
• •5. intolerance or poor candidate for oral appliance;
• •6. participant has provided informed consent for palate surgery as part of their standard of care;
• •7. tonsil size 0-2+ (without markedly enlarged tonsils that have high surgical success rates);
• •8. DISE without evidence of complete tongue-related obstruction (reflecting poorer results with isolated palate surgery);
• •9. medications stable for ≥2 months;
• •10. body mass index \<35 kg/m2;
• •11. absence of uncontrolled nasal obstruction;
• •12. no prior pharyngeal surgery other than tonsillectomy;
• •13. no neurologic, cardiac or pulmonary disorders;
• •14. absence of psychiatric disorder except for treated depression or mild anxiety;
• •15. no co-existing sleep disorder, such as narcolepsy, chronic insomnia, or restless legs syndrome;
• •16. no use of hypnotics, anxiolytics, stimulants, or sedating antidepressants;
• •17. no near-miss or prior motor vehicle crash due to sleepiness in past 12 months; and
• •18. \<3 caffeinated beverages daily.