The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews

Abstract

ObjectiveTonsillectomy with adenoidectomy is a combination surgery that has been used to treat pediatric obstructive sleep apnea (OSA). For adults, tonsillectomy has also been reported as a primary treatment modality when the tissue is hypertrophied. The objective of this study is to provide an overview of published systematic reviews and meta-analyses of tonsillectomy with or without adenoidectomy as used in the treatment of OSA in children and adults.Data sourcesNine databases, including PubMed/MEDLINE.Review methodsDatabases were searched from their inception through July 9, 2017. The PRISMA statement was followed.ResultsMore than 20 recent systematic reviews and meta-analyses were identified regarding tonsillectomy as a treatment modality for OSA. There were four articles that addressed tonsillectomy’s overall success, efficacy, and complications in otherwise healthy pediatric patients. Three studies evaluated tonsillectomy in obese children, and two specifically examined children with Down syndrome. Only one systematic review and meta-analysis discussed tonsillectomy as a treatment for OSA in the adult population.ConclusionTonsillectomy as an isolated treatment modality is rarely performed in pediatric patients with OSA; however, tonsillectomy is commonly performed in combination with adenoidectomy and the combination has demonstrated efficacy as the primary treatment option for most children. In the limited adult data, tonsillectomy alone for OSA has a surprising success rate; yet, more research is required to determine long-term improvement and need for further treatment.

Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery

“…However, it is important to highlight the fact that MLS surgery has resulted in a dramatic reduction in AHI that allows us to examine the difference in metabolites before and after surgery. Given the fact that tonsillectomy is a very common surgical procedure, particularly in children, its utility in treating OSA (as it improves the airflow and improves breathing) is also combined with an improved metabolic status [ 44 ].…”

Long‐term evaluation of satisfaction and side effects after modified uvulopalatopharyngoplasty

“…In the group of 15 patients with side effects after 24 months, the mean age was 52 years (range, 23-66 years), mean BMI was 28 kg/m 2 (range, 22-37 kg/m 2 ), mean AHI score was 28 (range, 2-78), and mean ESS score was 6 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15]. This was compared with the group of 34 patients without side effects with a mean age of 43 years (range, 23-62 years), mean BMI of 28 kg/m 2 (range, 21.4-33.8 kg/m 2 ), mean AHI score of 22 (range, 0-78), and mean ESS score of 6 (range, 2-17).…”

“…Tonsillectomy alone has been shown in a review to be effective in patients with tonsil hyperplasia, 3 but long-term data to support tonsillectomy as a primary surgical treatment for adults with OSA are lacking. 4 There are alternative techniques to UPPP, such as lateral pharyngoplasty with myotomy and repositioning of the muscles of the lateral pharyngeal wall. 5 However, there is an increased risk of side effects and increased complication rate with extended surgery, and the evidence for a demonstrated effect on OSA from these surgical alternatives is still low, even in the long term.…”

Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome

“…Another predisposing factor is adenotonsillar hypertrophy (AH), which is more frequent in preschoolers (3 to 5 years) [ 3 , 8 ]. Functional factors include neuromuscular diseases and nasal obstruction following viral infections [ 12 , 13 , 14 ]. Various studies have shown improvements in cognitive disorders after AT [ 15 ], probably before age 9, suggesting that the benefits of surgery decrease after this threshold age [ 16 ].…”