Transpalatal advancement pharyngoplasty for obstructive sleep apnea: a systematic review and meta-analysis.
The objective is to determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve after transpalatal advancement pharyngoplasty (TPAP) with obstructive sleep apnea (OSA) in adults, using a systematic review and meta-analysis. Nine databases, including PubMed/MEDLINE, were searched through April 1, 2016. All studies that included patients who underwent TPAP alone were included in this analysis. Fifty-six studies were potentially relevant, 37 were downloaded and five studies met criteria with 199 patients (age: 42.5 ± 9.7 years and body mass index: 29.0 ± 4.0 kg/m2). The grand mean (M) and standard deviation (SD) for AHI (199 patients) pre and post-TPAP decreased from 54.6 ± 23.0 [95 % CI 51.4, 57.8] to 19.2 ± 16.8 [95 % CI 16.9, 21.5] events/h (relative reduction: 64.8 %). Random effects modeling demonstrated a mean difference (MD) of -36.3 [95 % CI -48.5, -24.1], overall effect Z = 5.8 (p < 0.00001), and I2= 85 % (significant inconsistency). The standardized mean difference (SMD) for TPAP demonstrated a large magnitude of effect for AHI -1.76 [95 % CI -2.4, -1.1]. For LSAT (70 patients), the pre and post-TPAP M ± SD improved from 81.9 ± 8.1 [95 % CI 80.0, 83.8] to 85.4 ± 6.9 [95 % CI 83.8, 87.0], with a MD of 3.55, overall effect Z = 1.79 (p = 0.07). Thus far, few studies have evaluated transpalatal advancement pharyngoplasty; therefore, we recommend additional studies, especially prospective studies. Research comparing TPAP to pharyngoplasty procedures without palatal advancement would help determine the optimal role for this procedure.
Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.
Keith
K
Volner
John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA.
Brandyn
B
Dunn
Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.
Edward T
ET
Chang
Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.
Sungjin A
SA
Song
Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Stanley Yung-Chuan
SY
Liu
Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA.
Scott E
SE
Brietzke
Department of Otolaryngology - Head and Neck Surgery, Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, 78234, USA.
Peter
P
O'Connor
Division of Sleep Surgery and Medicine, Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA. drcamachoent@yahoo.com.|Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Stanford, CA, 95304, USA. drcamachoent@yahoo.com.
Macario
M
Camacho
D000328:Adult; D057186:Comparative Effectiveness Research; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010159:Palate / Q000601:surgery; D010614:Pharynx / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*
Meta-analysis; Obstructive sleep apnea; Sleep surgery; Systematic review; Transpalatal advancement pharyngoplasty