title: Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries.
  
  
  METHODS
  Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE.
  
  
  RESULTS
  351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea-hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of -0.78 (large magnitude of effect) [95% CI -1.06, -0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4-87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports.
  
  
  CONCLUSIONS
  Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m2and non-syndromic children have had the most improvement in AHI. The specific type of surgery must be tailored to the patient. Patients with co-morbidities should undergo treatment in centers that are equipped to provide appropriate perioperative care.
authors.affiliation: Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, 1 Jarrett White Rd, Honolulu, HI, 96859, USA. drcamachoent@yahoo.com.
authors.forename: Macario
authors.identifier: http://orcid.org/0000-0001-9200-9085
authors.initials: M
authors.lastname: Camacho
authors.affiliation: School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Noller
authors.affiliation: Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.affiliation: Division of Otolaryngology and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, Honolulu, HI, USA.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Reckley
authors.affiliation: Division of Otolaryngology and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, Honolulu, HI, USA.
authors.forename: Camilo
authors.initials: C
authors.lastname: Fernandez-Salvador
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Ho
authors.affiliation: University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868, USA.
authors.forename: Brandyn
authors.initials: B
authors.lastname: Dunn
authors.affiliation: Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94158, USA.
authors.forename: Dylan
authors.initials: D
authors.lastname: Chan
mesh_terms: D002648:Child; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D018579:Patient Selection; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D014059:Tongue / Q000601:surgery*
keywords: Children; Meta-analysis; Obstructive sleep apnea; Systematic review; Tongue