title: Temperature controlled radiofrequency ablation at different sites for treatment of obstructive sleep apnea syndrome: a systematic review and meta-analysis.
abstract: BACKGROUND
  This study seeks to determine the efficacy of temperature controlled radiofrequency tissue ablation (TCRFTA) to alleviate symptoms of obstructive sleep apnea (OSA) and reduce polysomnographic measures of OSA in the first year post-treatment.
  
  
  METHODS
  Systematic review and meta-analysis. Two independent searches of MEDLINE, EMBASE bibliographic databases, and Evidence Based Medicine Reviews to identify publications relevant to OSA and TCRFTA. Effectiveness of TCRFTA was measured separately for application of TCRFTA at the base of tongue and soft palate, and for multilevel intervention using the respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), Epworth sleepiness scale (ESS), and bed partner's rating of snoring using a visual analogue scale (VAS snoring). The most recent search was conducted in April 2013. Statistical analysis was performed using Review Manager Version 5.2 using a relative measure of effect, i.e., ratio of means (RoM).
  
  
  RESULTS
  Our initial search resulted in 29 eligible studies, and subsequently, 20 studies were included in the meta-analysis. Substantial and consistent improvement in PSG and subjective outcomes were observed post-TCRFTA in the base of tongue (BOT) and multilevel surgery groups only. Application of TCRFTA at the BOT was associated with a significant reduction in RDI (RoM 0.60, CI 0.47-0.76), ESS (RoM 0.59, CI 0.51-0.67), and VAS snoring (RoM 0.48, CI 0.37-0.62) and increase in lowest oxygen saturation (RoM 1.05, CI 1.01-1.10). Similarly, a significant reduction in RDI (RoM 0.61, CI 0.47-0.80) and ESS (RoM 0.79, CI -0.71 to 0.88) was observed after multilevel TCRFTA, but substantial heterogeneity between these studies was observed.
  
  
  CONCLUSIONS
  TCRFTA is clinically effective in reducing RDI levels and symptoms of sleepiness in patients with OSA syndrome when directed at the base of tongue or as a multilevel procedure.
authors: Department of Internal Medicine, University at Buffalo, Buffalo, NY, USA.
authors: Ridhwan Y
authors: RY
authors: Baba
authors: Arjun
authors: A
authors: Mohan
authors: V V S Ramesh
authors: VV
authors: Metta
authors: M Jeffery
authors: MJ
authors: Mador
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D006801:Humans; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D013696:Temperature
references: Laryngoscope. 2009 Aug;119(8):1621-7
references: 19504550
references: Am J Respir Crit Care Med. 1994 Jan;149(1):149-54
references: 8111574
references: Am Rev Respir Dis. 1991 Nov;144(5):1130-3
references: 1952444
references: Otolaryngol Head Neck Surg. 2003 Jun;128(6):848-61
references: 12825037
references: Acta Otolaryngol. 2000 Oct;120(8):981-5
references: 11200595
references: Laryngoscope. 2004 Dec;114(12):2073-84
references: 15564825
references: Otolaryngol Head Neck Surg. 2009 Dec;141(6):722-6
references: 19932844
references: Arch Otolaryngol Head Neck Surg. 2009 Sep;135(9):915-9
references: 19770425
references: BMJ. 2006 Sep 16;333(7568):597-600
references: 16974018
references: Sleep Breath. 2010 Jun;14(2):125-30
references: 19727880
references: Sleep Med Rev. 2002 Jun;6(3):195-212
references: 12531121
references: Eur Arch Otorhinolaryngol. 2009 Sep;266(9):1469-73
references: 19023583
references: Am J Respir Crit Care Med. 2006 Sep 1;174(5):605-14
references: 16931644
references: Otolaryngol Head Neck Surg. 2008 Sep;139(3):378-84; discussion 385
references: 18722216
references: Eur Arch Otorhinolaryngol. 2014 Nov;271(11):2863-70
references: 24510179
references: Ann Intern Med. 2012 Jan 17;156(2):115-22
references: 22250142
references: Eur Respir J. 2002 Dec;20(6):1511-8
references: 12503712
references: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD001106
references: 16437429
references: Am Rev Respir Dis. 1992 Apr;145(4 Pt 1):841-5
references: 1554212
references: Control Clin Trials. 1986 Sep;7(3):177-88
references: 3802833
references: Am J Respir Crit Care Med. 2007 Nov 15;176(10):954-6
references: 17823357
references: Laryngoscope. 2014 Aug;124(8):1970-4
references: 24382820
references: Otolaryngol Head Neck Surg. 2002 Oct;127(4):315-23
references: 12402011
references: BMJ. 2003 Sep 6;327(7414):557-60
references: 12958120
references: Laryngoscope. 2002 Nov;112(11):2086-92
references: 12439186
references: Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2007 Nov;21(21):981-4
references: 18309654
references: Otolaryngol Head Neck Surg. 2004 May;130(5):579-85
references: 15138424
references: Zhonghua Yi Xue Za Zhi. 2001 Nov 10;81(21):1306-8
references: 16200723
references: Eur Arch Otorhinolaryngol. 2006 Nov;263(11):1031-40
references: 16862445
references: Chest. 1990 Jan;97(1):33-8
references: 2403899
references: JAMA. 2004 Apr 28;291(16):2013-6
references: 15113821
references: Chest. 1994 Feb;105(2):429-33
references: 8306741
references: Otolaryngol Head Neck Surg. 2002 Sep;127(3):230-4
references: 12297815
references: Sleep Breath. 2014 Sep;18(3):453-65
references: 24859484
references: Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2008 Jun;22(12):558-9
references: 18800685
references: Laryngoscope. 2006 Oct;116(10 ):1887-93
references: 17003707
references: Otolaryngol Head Neck Surg. 1999 May;120(5):656-64
references: 10229589
references: J Otolaryngol. 2001 Aug;30(4):193-8
references: 11771028
references: J Laryngol Otol. 2005 Nov;119(11):888-93
references: 16354341
references: Sleep. 2008 Aug;31(8):1079-85
references: 18714779
references: Eur Respir J. 1988 May;1(5):436-8
references: 3049136
references: Acta Otolaryngol. 2004 Sep;124(7):827-32
references: 15370568
references: Am J Respir Crit Care Med. 2009 Feb 1;179(3):235-40
references: 19011148
references: Laryngoscope. 2003 Oct;113(10):1786-91
references: 14520107
references: Otolaryngol Head Neck Surg. 2001 Oct;125(4):303-11
references: 11593163
references: Otolaryngol Head Neck Surg. 2003 Jul;129(1):37-42
references: 12869914
references: Eur Ann Otorhinolaryngol Head Neck Dis. 2014 Feb;131(1):27-31
references: 24439763
references: Chest. 2005 Aug;128(2):624-33
references: 16100147
references: Eur Arch Otorhinolaryngol. 2012 Jan;269(1):321-30
references: 21626124
references: Sleep Breath. 2000;4(4):155-162
references: 11894201
references: Am J Otolaryngol. 2009 Nov-Dec;30(6):401-6
references: 19880029
references: N Engl J Med. 2005 Nov 10;353(19):2034-41
references: 16282178
references: J Clin Epidemiol. 2011 May;64(5):556-64
references: 21447428
references: Sleep. 2008 Aug;31(8):1071-8
references: 18714778
references: Otolaryngol Head Neck Surg. 2005 Apr;132(4):630-5
references: 15806059
references: Acta Otolaryngol. 2002 Jul;122(5):531-6
references: 12206264