Systematic review and updated meta-analysis of multi-level surgery for patients with OSA
Su YY, Lin PW, Lin HC, et al. Systematic review and updated meta-analysis of multi-level surgery for patients with OSA [published online ahead of print, 2021 Nov 1]. Auris Nasus Larynx. 2021;S0385-8146(21)00247-9. doi:10.1016/j.anl.2021.10.001
Objectives: To perform an updated systematic review for determining the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea/hypopnea syndrome (OSA).
Methods: A systematic review was performed to identify English-language studies that evaluated the treatment of adult OSA patients with multilevel OSA surgery up to January, 2018. We used polysomnography as a metric of treatment success. Articles were only included if the surgery intervention involved at least two of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Eighty-seven studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success.
Results: The meta-analysis included 3931 subjects with a mean age of 46.1 years. The originally reported success rate in the included literature was 59.9%. A meta-analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria - namely "a reduction in apnea/hypopnea index (AHI, /hr.) of 50% or more and an AHI of less than 20". The recalculated success rate was 60.2%. Standard meta-analytic techniques for combining p-values between studies after weighting for sample size found significant improvements in AHI, apnea index, % of rapid eye movement sleep, lowest saturation of oxygen (%), and Epworth Sleepiness Scale.
Conclusion: This study shows the significant improvement of treatment outcomes with multilevel surgery for OSA patients.