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Tracheostomy as Treatment for Adult Obstructive Sleep Apnea
Author(s) -
Camacho Macario,
Certal Victor,
Brietzke Scott E.,
Holty JonErik C.,
Guilleminault Christian,
Capasso Robson
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24433
Subject(s) - medicine , polysomnography , obstructive sleep apnea , apnea , cochrane library , meta analysis , sleep apnea , medline , apnea–hypopnea index , hypopnea , anesthesia , political science , law
Objectives/Hypothesis To systematically review outcomes for polysomnography, sleepiness, and mortality in patients who undergo tracheostomy for the treatment of adult obstructive sleep apnea (OSA). Data Sources MEDLINE, Scopus, and the Cochrane Library were searched from inception to March 2013, followed by extensive hand searching for the identification of relevant English language studies that met predefined criteria. Review Methods Adult studies of tracheostomies or tracheotomies as treatment for OSA with outcomes for apnea index (AI), apnea–hypopnea index (AHI), oxygen desaturation index (ODI), effect on daytime sleepiness or mortality were identified, abstracted and pooled (as appropriate). Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. Results The systematic search identified 18 relevant studies that were primarily case series, using retrospective review. Posttracheostomy AI improved from 73.0 ± 27.1 to 0.2 ± 1.2/h and an AI mean difference of −83.47 (95% CI, −106.07 to −60.87; P < 0.0001). Mean AHI decreased from 92.0 ± 34.8 to 17.3 ± 20.5/h and an AHI mean difference −79.82 (95% CI, −63.74 to −95.90; P < 0.0001) compared with preoperative status was observed. Postsurgically, there was a development of central apneas; however, the central AI demonstrated near normalization to a mean of 2.1 ± 3.5/h after 14 weeks. ODI decreased from 78.2 ± 25.8/h to 20.8 ± 25.5/h. Four studies demonstrated a statistically significant improvement in subjective sleepiness posttracheostomy. Postoperative statistically significant reductions in overall and in cardiovascular mortality compared with untreated historical cohorts was reported. Conclusion Tracheostomies significantly decrease apnea index, oxygen desaturation index, sleepiness, and mortality in OSA subjects. Level of Evidence NA. Laryngoscope , 124:803–811, 2014