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Multilevel Palate and Tongue Base Surgical Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta‐analysis
Author(s) -
Mulholland Graeme B.,
Jeffery Caroline C.,
Ziai Hedyeh,
Hans Varinder,
Seikaly Hadi,
Pang Kenny P.,
Rotenberg Brian W.
Publication year - 2019
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.27597
Subject(s) - medicine , obstructive sleep apnea , meta analysis , hypopnea , confidence interval , sleep apnea , apnea , systematic review , polysomnography , body mass index , overweight , apnea–hypopnea index , medline , physical therapy , political science , law
Objective To evaluate multilevel palate and tongue base surgery as a method of treatment of obstructive sleep apnea by comparing the pre‐ and postoperative apnea‐hypopnea index. Methods We conducted a systematic review. MEDLINE and Embase databases were searched in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for conducting systematic reviews. Two authors screened all articles and performed methodological quality assessment. Relevant articles where reviewed in detail. Standard inclusion criteria were applied for article selection. Relevant data were extracted and summarized, a difference of means random‐effects model was performed. Our primary outcome measure was change in apnea‐hypopnea index pre‐/postsurgical treatment. Results Of 1,172 studies identified from January 2006 to March 2017, 46 studies met inclusion criteria and were included in the systematic review. This included 11 surgical subgroups and 1,806 patients. Methodological quality and risk of bias assessments were completed. There was strong male predominance 86.8 (standard deviation [SD] = 10.3%), and the average age was 46.8 (SD = 4.0) years. All studies included overweight to obese patients (average body mass index = 29.1 [SD = 3.5]). The average preoperative apnea‐hypopnea index was 39.0 (SD = 15.4), and the average postoperative apnea‐hypopnea index decreased to 18.3 (SD = 7.5). Meta‐analysis data yielded a decrease in apnea‐hypopnea index of −23.67 with a 95% confidence interval of −27.27 to −20.06. Conclusions Non–maxillomandibular advancement, multilevel surgical procedures for obstructive sleep apnea demonstrate significant improvements in reduction of apnea‐hypopnea index following surgery in addition to improvement in many other sleep‐specific outcomes. Future research should include larger, higher‐level studies that compare surgical treatments and identify factors associated with outcomes. Level of Evidence NA Laryngoscope , 129:1712–1721, 2019