title: Tracheostomy as treatment for adult obstructive sleep apnea: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review outcomes for polysomnography, sleepiness, and mortality in patients who undergo tracheostomy for the treatment of adult obstructive sleep apnea (OSA).
  
  
  METHODS
  MEDLINE, Scopus, and the Cochrane Library were searched from inception to March 2013, followed by extensive hand searching for the identification of relevant English language studies that met predefined criteria.
  
  
  METHODS
  Adult studies of tracheostomies or tracheotomies as treatment for OSA with outcomes for apnea index (AI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), effect on daytime sleepiness or mortality were identified, abstracted and pooled (as appropriate). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
  
  
  RESULTS
  The systematic search identified 18 relevant studies that were primarily case series, using retrospective review. Posttracheostomy AI improved from 73.0 ± 27.1 to 0.2 ± 1.2/h and an AI mean difference of -83.47 (95% CI, -106.07 to -60.87; P < 0.0001). Mean AHI decreased from 92.0 ± 34.8 to 17.3 ± 20.5/h and an AHI mean difference -79.82 (95% CI, -63.74 to -95.90; P < 0.0001) compared with preoperative status was observed. Postsurgically, there was a development of central apneas; however, the central AI demonstrated near normalization to a mean of 2.1 ± 3.5/h after 14 weeks. ODI decreased from 78.2 ± 25.8/h to 20.8 ± 25.5/h. Four studies demonstrated a statistically significant improvement in subjective sleepiness posttracheostomy. Postoperative statistically significant reductions in overall and in cardiovascular mortality compared with untreated historical cohorts was reported.
  
  
  CONCLUSIONS
  Tracheostomies significantly decrease apnea index, oxygen desaturation index, sleepiness, and mortality in OSA subjects.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, U.S.A.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brietzke
authors.forename: Jon-Erik C
authors.initials: JE
authors.lastname: Holty
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D017286:Polysomnography / Q000379:methods; D011379:Prognosis; D011659:Pulmonary Gas Exchange; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Tracheostomy; obstructive sleep apnea