title: Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal.
abstract: Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed.
authors.affiliation: Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, HI 96859, USA; Stanford Hospital and Clinics, Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford, CA 94063, USA.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Stanford, CA 94063, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.affiliation: Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, HI 96859, USA.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Chang
authors.affiliation: Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, HI 96859, USA.
authors.forename: Sungjin A
authors.initials: SA
authors.lastname: Song
authors.affiliation: Wright State University Boonshoft School of Medicine, Dayton, OH 45435, USA.
authors.forename: Blake
authors.initials: B
authors.lastname: Szelestey
authors.affiliation: Department of Otorhinolaryngology, Sleep Medicine Centre, Hospital CUF Porto, 4100-180 Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, 4200-450 Porto, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal