DOI: https://doi.org/10.36347/sjams.2026.v14i03.003

Pages: 333-337

Background: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder associated with cardiovascular, metabolic, and neurocognitive complications. Continuous positive airway pressure (CPAP) is the standard treatment; however, poor long-term adherence limits its effectiveness. Sleep surgery has emerged as an alternative for patients with severe OSA who are intolerant to CPAP, but real-world outcome data remain limited, especially in low- and middle-income countries. Objective: To evaluate the outcomes of multilevel sleep surgery in patients with very severe OSA. Methods: This retrospective observational study included 50 adults (age 18–70 years) with very severe OSA (apnea–hypopnea index [AHI] ≥50 events/hour and 3% oxygen desaturation index [ODI] >40 events/hour) who underwent multilevel upper airway surgery at Malleus ENT Specialized Hospital Limited in Dhaka, Bangladesh, between June 2023 and June 2024. Preoperative assessment included clinical evaluation, BMI measurement, tonsil grading, Friedman staging, and flexible nasendoscopy. Surgical interventions included modified uvulopalatopharyngoplasty with radiofrequency tongue base procedures, tonsillectomy, lingual tonsillectomy, midline glossectomy, and trans-palatal advancement pharyngoplasty. Primary outcome was postoperative change in AHI. Secondary outcomes included 3% ODI, lowest oxygen saturation, snoring severity, Epworth Sleepiness Scale scores, BMI, and surgical complications. Results: The cohort had a mean age of 42 ± 12 years and was predominantly male (80%). High-grade tonsillar hypertrophy (grades 3–4) was present in 60% of patients, and 38% had advanced Friedman stage (3–4). Most patients underwent multilevel surgery, with modified UPPP and radiofrequency tongue base procedures being most common (54%). Postoperative evaluation demonstrated significant improvement in objective outcomes: mean AHI decreased from 68.5 ± 15.8 to 15.2 ± 12.4 events/hour (p < 0.01), 3% ODI decreased from