Updated Systematic Review of Multilevel Surgery for Patients with OSA

Abstract

Objectives:

Perform an updated systematic review and meta-analysis to determine the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea 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 May, 2013. We used polysomnography as a metric of treatment success. Articles were included only if the surgery intervention involved at least 2 of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Seventy-three studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success.

Results:

The meta-analysis included 3147 subjects with a mean age of 45.0 years. The originally reported success rate in the included literature was 59.8%. A meta-analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria, “a reduction in AHI [apnea-hypopnea index] of 50% or more and an AHI of less than 20.” The recalculated success rate was 61.4%. Standard meta-analytic techniques for combining p-values between studies after weighting for sample size found significant improvements in AI, AHI, %REM sleep, LSAT, snoring visual analog scale, and Epworth Sleepiness Scale.

Conclusions:

This study shows the significant benefits of multilevel surgery for OSA patients.