Abstract
Objective: 1) Review the available literature reporting on the success of single and multi-level sleep surgery in relation to Friedman Anatomical Staging (FAS). 2) Combine statistical outcomes of multiple studies (where appropriate) to determine surgical success rates (defined by postoperative apnea-hypopnea index [AHI] <20 and 50% reduction) for each clinical stage.
Method: PubMed, MEDLINE, and Cochrane Trial Registry (through 12/2011) were searched, combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random-effects meta-analysis of studies assessing the success of sleep surgery in relation to FAS were performed. Outcomes are reported as proportional success rates.
Results: Six studies met inclusion criteria and had data suitable for pooling (521 patients). Success rate (SR) for single-level palatal surgery with FAS-1 was .806 (.630, .910; P = .002). Multi-level surgical data for FAS-1 yielded SR .706 (.458, .872; P = .1). Single-level surgery for FAS-2 yielded SR .379 (.224, .564; P = .197). Multi-level surgical data for FAS-2 yields SR .647 (.527, .751; P = .017). Single-level surgery for FAS-3 yields SR .081 (.037, .169; P < .001). Multi-level surgery for FAS-3 yields SR .412 (.254, .591; P = .334). Analysis of publication bias yielded non-significant Egger’s regression intercepts for studies reporting FAS-2/3 success. Too few studies reported FAS-1 success to allow statistical analysis of publication bias.
Conclusion: These findings demonstrate the utility of FAS in predicting the success of OSA surgery. Findings further reinforce the value of OSA surgery in patients with FAS-1 regardless of disease severity. In addition, they add to the evidence that multi-level surgery is often necessary to treat patients with more advanced staging.
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