Dr. Kezirian is actively engaged in a wide variety of research efforts, and he is recognized nationally and internationally for this work.  His research has been sponsored by the National Institutes of Health (NIH), the American Academy of Otolaryngology—Head and Neck Surgery Foundation, and the American Laryngological, Rhinological, and Otological Society (aka Triological Society). These investigations are also supported by the resources of the UCSF CTSI Clinical Research Center and the UCSF Center for Clinical Research in Otolaryngology. As the surgical treatment of snoring and obstructive sleep apnea are relatively new fields, Dr. Kezirian takes pride in using the knowledge gained from research to teach patients and other physicians and to provide the highest quality of care to his patients.

Drug-Induced Sleep Endoscopy

There are many surgical treatments available to treat the different structures of the nose and throat that can play important roles in causing snoring and obstructive sleep apnea. Successful surgical treatment is based on accurately identifying where the snoring and blockage in breathing is occurring and developing targeted, effective treatment. Dr. Kezirian jokes that he could come to each patients' home and look inside their throat with a flexible fiberoptic telescope to watch the areas where blockage in breathing occurs as they sleep, all night, every night. Of course, this would be a little challenging.

Drug-induced sleep endoscopy was developed in Europe to allow surgeons to look inside the throat with a flexible fiberoptic endoscope while a patient was sedated in the operating room instead. Dr. Kezirian is one of the world's leaders in evaluation techniques that are essential to selecting surgical procedures, including drug-induced sleep endoscopy. His research has evaluated important characteristics of drug-induced sleep endoscopy, compared it to other evaluations, and examined surgical results. For additional information about this ongoing research, please see the National Institutes of Health's clinicaltrials.gov website.

Sleep Apnea Surgical Practice Patterns and Procedure Selection
A first study examined national obstructive sleep apnea surgical treatment patterns using large databases developed by the Agency for Healthcare Research and Quality. This work characterized the number, types, and costs of surgeries performed in the United States. An estimated 35,000 procedures were performed nationally to treat obstructive sleep apnea in 2006, but only 20% included procedures to treat blockage in breathing in the tongue region. Research studies, including Dr. Kezirian's own work, suggest that blockage in the tongue region occurs much more often than in just 20% of cases.

To explore the factors involved in procedure selection, Dr. Kezirian completed a second study, finding that insufficient training in these techniques is a major barrier to performing tongue region procedures for many surgeons. As many of these procedures are relatively new, technically more difficult, and associated with a higher risk of complications, Dr. Kezirian is committed to the training of surgeons across the country and around the world in the techniques and the avoidance of complications.

The findings of this research are presented in more detail on a posting on Dr. Kezirian's blog.

Measuring the Effectiveness of Sleep Apnea Surgery
Obstructive sleep apnea is treated because it has important adverse effects on health and daytime function (sleepiness, quality of life, and alertness). Surgical outcomes are measured by comparing the preoperative and postoperative sleep studies to determine the improvement in breathing patterns. While this is essential, this research considered the potential benefits on health and daytime function with a combination of blood tests and questionnaires. This published study showed that patients who achieve resolution of significant sleep apnea also have marked improvement in health and daytime function, but some patients whose sleep apnea did not resolve can also improve in daytime function. For additional information, please see the description at the National Institutes of Health website.

Effects of Obstructive Sleep Apnea in Older Adults
Most of the research describing the impact of obstructive sleep apnea has focused on young and middle-aged adults. Two large, national studies coordinated through the University of California, San Francisco are permitting the evaluation of the impacts in older women and men. Dr. Kezirian has worked with the lead investigators from these studies to examine the quality of life and health consequences of obstructive sleep apnea in older adults. Multiple previous studies have shown that many individuals over 60 years of age have decreased sleep time. These studies were the first to show that symptoms that are commonly associated with sleep apnea, such as sleepiness and decreased quality of life due to sleep issues, are more closely related to sleep time rather than sleep apnea.