title: The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis.
abstract: Background /Aims: The aim of this study was to determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP). A secondary objective was to determine if a decrease in CPAP from UAS increases CPAP adherence.
  
  
  METHODS
  Studies were eligible for inclusion if a CPAP titration was performed both prior and following UAS in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after UAS were included to evaluate the secondary objective.
  
  
  RESULTS
  A total of 11 articles involving 323 patients were included in the review. The results show that there was a mean reduction in CPAP of 1.40 cm H2O (95% CI -2.08 to -0.73). Four of the 11 papers, with a total of 80 patients, evaluated CPAP adherence and found a significant 0.62-hour improvement on average (95% CI 0.22-1.01).
  
  
  CONCLUSIONS
  Due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea-hypopnea index and modestly reduces CPAP while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an adjunctive role in the management of OSA.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, S.C., USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Ayers
authors.forename: Shivangi
authors.initials: S
authors.lastname: Lohia
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: M Boyd
authors.initials: MB
authors.lastname: Gillespie
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D006801:Humans; D009666:Nose / Q000601:surgery; D010159:Palate / Q000601:surgery*; D010349:Patient Compliance; D010614:Pharynx / Q000601:surgery*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000503:physiopathology / Q000601:surgery*