Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis

Camacho, Macario; Noller, Michael; Zaghi, Soroush; Reckley, Lauren K.; Fernandez-Salvador, Camilo; Ho, Erika; Dunn, Brandyn; Chan, Dylan K.

doi:10.1007/s00405-017-4545-4

Cited by 16 publications

(7 citation statements)

References 69 publications

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“…21,27,31,33,34 A recent meta-analysis showed that the average AHI improvement for BOT reduction was 6.92 in 109 pediatric patients; it also demonstrated the greater effectiveness of BOT surgery in patients with normal weight and in nonsyndromic children. 37 In our study, more patients underwent LT, with or without MPG, than MPG alone. Few studies have examined isolated MPG outcomes for OSA improvement in children, although much is written on the theory and technique.…”

Section: Discussionmentioning

confidence: 60%

Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea

Williamson

McArdle

Morrow

et al. 2022

Otolaryngol.--head neck surg.

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Objective Drug-induced sleep endoscopy–directed lingual tonsillectomy and midline posterior glossectomy have been employed for the treatment of obstructive sleep apnea in children. The purpose of this study is to evaluate outcomes in children undergoing lingual tonsillectomy, midline posterior glossectomy, or combined base of tongue reduction procedures for obstructive sleep apnea. Study Design Case series with chart review. Setting Tertiary care academic medical center. Methods A case series was performed with chart review of pediatric patients with obstructive sleep apnea who underwent base of tongue surgery as directed by drug-induced sleep endoscopy. Pre- and postoperative obstructive apnea-hypopnea index (oAHI) was compared. Age, sex, body mass index z score, and medical history were also evaluated. Results A total of 168 children were included, with a mean ± SD age of 8.3 ± 3.6 years. Of these patients, 101 underwent lingual tonsillectomy alone; 25, midline posterior glossectomy alone; and 42, both. Their mean oAHI improvement was 3.52 ± 8.39, 2.55 ± 5.59, and 3.70 ± 6.07, respectively. Each surgical group experienced significant improvement in sleep apnea when pre- and postoperative oAHI was compared ( P < .01). Overall surgical success, as defined by oAHI <1 (or <5 without clinical symptoms), was 75% (126 patients). Conclusion When guided by drug-induced sleep endoscopy, pediatric tongue base surgery can significantly improve oAHI and thus demonstrates promising success in treating pediatric obstructive sleep apnea.

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Section: Discussionmentioning

confidence: 60%

Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea

Williamson

McArdle

Morrow

et al. 2022

Otolaryngol.--head neck surg.

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“…In a review and meta‐analysis of isolated tongue base surgery (base of tongue reduction, n = 114), hypoglossal nerve stimulation (n = 1), and tongue suspension (n = 1) for OSA in children, Camacho et al 24 identified 70 of 114 (61%) patients who had both BMI and outcome data available. These included normal‐weight, overweight, and obese children.…”

Section: Resultsmentioning

confidence: 99%

“…The graded effects of increasing weight on surgical outcomes can best be demonstrated using data from tongue base surgery. Increasing BMI z score was associated with increasing postoperative AHI in children undergoing lingual tonsillectomy, 24 and increasing BMI weight category was associated with worse outcomes following midline posterior glossectomy, 20,24 to the point where none of the children who were obese preoperatively improved and most gained weight following surgery 20 . However, these studies had small sample sizes, thus limiting generalizability.…”

Section: Discussionmentioning

confidence: 99%

Surgery for Obstructive Sleep Apnea in Obese Children: Literature Review and Meta‐analysis

Scheffler

Wolter

Narang

et al. 2019

Otolaryngol.--head neck surg.

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Objectives Surgical intervention for obstructive sleep apnea (OSA) in overweight and obese children may not be as effective as it is in normal-weight children. The purpose of this study was to systematically review the effects of various surgical interventions for OSA in obese children and to meta-analyze the current data. Data Sources PubMed, OVID, and Cochrane databases. Review Methods Databases were searched for studies examining adenotonsillectomy, uvulopalatopharyngoplasty, supraglottoplasty, or tongue base surgeries and combinations in obese children with OSA. Adenotonsillectomy was the only procedure with enough data for meta-analysis; polysomnographic data were extracted and analyzed using a random-effects model. Results For adenotonsillectomy, 11 studies were included in the meta-analysis. Despite significant improvement in the apnea-hypopnea index (22.9 to 8.1 events/h, P < .001), respiratory disturbance index (24.8 to 10.4 events/h, P < .001), and oxygen saturation nadir (78.4% to 87.0%, P < .001), rates of persistent OSA ranged from 51% to 66%, depending on the outcome criterion used. There was evidence of limited effectiveness for surgical interventions to treat OSA in obese children using uvulopalatoplasty (12.5%) and tongue base surgery (74%-88%). Conclusions Surgical interventions for OSA in overweight and obese children are effective at reducing OSA but with higher rates of persistent OSA than reported for normal-weight children. However, the amount of reduction appears to vary by surgical procedure. More attention should be paid toward preoperative weight loss and patient selection, and parents should be provided with realistic postoperative expectations in this difficult-to-treat population.

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“…The surgical procedures reduced the mean preoperative and postoperative AHI from 16.9 ± 12.2/h to 8.7 ± 10.6/h (by 48.5%) in all 114 patients. Nonsyndromic children and children with a BMI < 25 kg/m 2 showed the most improvement in AHI [ 49 ]. More than 90% of patients who underwent tongue-base reduction surgery had previously undergone AT.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

et al. 2020

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Continuous positive airway pressure (CPAP) is considered first-line treatment in the management of pediatric patients without a surgically correctible cause of obstruction who have confirmed moderate-to-severe obstructive sleep apnea (OSA). The evidence supports its reduction on patient morbidity and positive influence on neurobehavioral outcome. Unfortunately, in clinical practice, many patients either refuse CPAP or cannot tolerate it. An update on alternative approaches to CPAP for the management of OSA is discussed in this review, supported by the findings of systematic reviews and recent clinical studies. Alternative approaches to CPAP and adenotonsillectomy for the management of OSA include weight management, positional therapy, pharmacotherapy, high-flow nasal cannula, and the use of orthodontic procedures, such as rapid maxillary expansion and mandibular advancement devices. Surgical procedures for the management of OSA include tongue-base reduction surgery, uvulopalatopharyngoplasty, lingual tonsillectomy, supraglottoplasty, tracheostomy, and hypoglossal nerve stimulation. It is expected that this review will provide an update on the evidence available regarding alternative treatment approaches to CPAP for clinicians who manage patients with pediatric OSA in daily clinical practice.

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Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis

Cited by 16 publications

References 69 publications

Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea

Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea

Surgery for Obstructive Sleep Apnea in Obese Children: Literature Review and Meta‐analysis

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

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