Multilevel Palate and Tongue Base Surgical Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta‐analysis

Abstract

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.Key Words: Obstructive sleep apnea, surgical treatment of obstructive sleep apnea, sleep medicine, sleep apnea, quality of life.

Airflow dynamics in obese minipigs with obstructive sleep apnea

“…This finding is consistent with a number of clinical studies ( Simpson et al., 2018 ). Therefore, various surgical treatments have been focused on reducing the tissue mass of this region for airway expansion ( Mulholland et al., 2019 ) and the study also found that this region was mostly affected by the type of masks ( Ebben et al., 2016 ).…”

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

“…The effectiveness of sleep surgery in treating OSA remains controversial 34,47 . Several surgical procedures have been proposed, including nasal surgery, 48,49 uvulopalatopharyngoplasty, 50 pharyngeal surgery, 51 tongue base surgery, 52 multilevel surgery, 53,54 maxillomandibular advancement, 55,56 hyoid surgery, 57 tracheostomy, 58 and hypoglossal nerve stimulation 59,60 . Studies have described disparities in the outcomes of different surgical procedures 61 ; accordingly, the identification of predictive factors for poor outcomes and appropriate selection of patients are critical 62,63 …”

The role of skeletal surgical treatment in the management of obstructive sleep apnea: an overview

“…It appears that there has been more discussion on soft than hard tissue surgeries in recent years. There has been a rise of bariatric surgery prior to other forms of surgeries, multilevel surgery at palate, pharynx, and tongue base, transoral robotic surgery at tongue base, and radiofrequency surgeries (66)(67)(68). The DOME technique for narrow and deep vaulted maxilla is one that was more well-known to surgeons.…”