title: Laser-Assisted Uvulopalatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.
abstract: Laser-assisted uvulopalatoplasty (LAUP) has been used as treatment for obstructive sleep apnea (OSA). The objective of this study was to perform a systematic review and meta-analysis for LAUP alone as treatment for OSA in adults.
  
  
  
  Three authors searched five databases (including PubMed/MEDLINE) from inception through October 30, 2016 for peer-reviewed studies, with any design/language. A study quality assessment tool was used. The PRISMA statement was followed. A meta-analysis was performed.
  
  
  
  Twenty-three adult studies (717 patients) reported outcomes (age: 50 ± 9 years, body mass index: 29 ± 4 kg/m2). The pre- and post-LAUP means (M) ± standard deviations (SDs) for apnea-hypopnea index (AHI) were 28 ± 13 and 19 ± 12 events/h (32% reduction). Random effects modeling for 519 patients demonstrated an AHI mean difference (MD) of -6.56 [95% CI -10.14, -2.97] events/h. Individual patient data analyses demonstrate a 23% success rate (≥50% reduction in AHI and <20 events/h) and an 8% cure rate. Additionally, 44% of patients had worsening of their AHI after LAUP. Lowest oxygen saturation (LSAT) improved from a M ± SD of 80 ± 8% to 82 ± 7%. A limitation is that most studies were case series studies and only two were randomized controlled trials.
  
  
  
  In this meta-analysis, LAUP reduced AHI by 32% among all patients; while the LSAT only changed minimally. Individual data demonstrated a success rate of 23%, cure rate of 8%, and worsening of the AHI among 44% of patients. We recommend that LAUP be performed with caution or not performed at all given the unfavorable results of currently published studies.
authors.affiliation: Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, HI.|Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
authors.affiliation: F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD.
authors.forename: N Blaine
authors.initials: NB
authors.lastname: Nesbitt
authors.affiliation: F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD.
authors.forename: Evan
authors.initials: E
authors.lastname: Lambert
authors.affiliation: Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Sungjin A
authors.initials: SA
authors.lastname: Song
authors.affiliation: Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Stanley Y
authors.initials: SY
authors.lastname: Liu
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
mesh_terms: D006801:Humans; D053685:Laser Therapy; D010159:Palate / Q000503:physiopathology / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*; D014609:Uvula / Q000503:physiopathology / Q000601:surgery*
keywords: laser-assisted uvulopalatoplasty; meta-analysis.; sleep apnea syndromes; systematic review