Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis.
A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.
Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN, USA.
Sean M
SM
Caples
James A
JA
Rowley
Jeffrey R
JR
Prinsell
John F
JF
Pallanch
Mohamed B
MB
Elamin
Sheri G
SG
Katz
John D
JD
Harwick
D000328:Adult; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008875:Middle Aged; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery