title: Reviewing the systematic reviews in OSA surgery.
abstract: OBJECTIVE
  There is an extensive amount of literature on surgeries as treatment for obstructive sleep apnea syndrome on adults. Previous systematic reviews have been performed to summarize the outcomes for sleep surgeries, with conflicting results. The objective of this study was to critically evaluate these systematic reviews to provide an overview of their quality, strengths, and conclusions.
  
  
  METHODS
  MEDLINE, Scopus, and the Cochrane Collaboration databases were searched from inception to April 2013.
  
  
  METHODS
  An overview of systematic reviews was undertaken. Studies included in this review are the systematic reviews whose primary objective was to evaluate the outcomes of sleep apnea surgery on adults. The methodological quality of the studies was analyzed with AMSTAR checklist, and the quality of evidence was evaluated using the GRADE assessment tool. Primary outcome measures assessed the effect of surgery on snoring, sleepiness, and the apnea-hypopnea index.
  
  
  RESULTS
  A total of 11 studies were included in this study, and the pooled overview includes 378 studies. The systematic reviews were mostly graded as low quality using the GRADE tool and low to moderate according to the AMSTAR checklist. Outcome for apnea-hypopnea index demonstrated substantial variation leading to conflicting results. Despite a high amount of heterogeneity, outcomes for sleepiness and snoring demonstrated significant improvement across included reviews.
  
  
  CONCLUSIONS
  Although obstructive sleep apnea surgery is associated with improved outcomes in most studies, the level and quality of evidence reviews requires improvement.
authors.affiliation: Department of Otorhinolaryngology, Hospital Sao Sebastiao, Sta Maria da Feira, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
authors.forename: Naoya
authors.initials: N
authors.lastname: Nishino
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D006801:Humans; D012891:Sleep Apnea Syndromes / Q000601:surgery; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D012913:Snoring / Q000601:surgery; D016896:Treatment Outcome
keywords: adult sleep apnea; obstructive sleep apnea syndrome; sleep surgery; systematic review