Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis

Abstract

A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.

Palatometry in South Indian Skulls and Its Clinical Implications

“…Palatal measurements form fundamental basis for orthodontic planning such as upper tooth extraction, maxillary dental implants, hemi-maxillectomy, orthognathic surgery, Le Fort fracture management, and cleft palate surgery [9]. Palatometry is also useful for preoperative evaluation of patients with uvulopalatopharyngoplasty [17].…”

Surgical Therapy of Obstructive Sleep Apnea: A Review

“…Success rates for isolated UPPP in the treatment of OSA are highly variable, depending on the size of the tonsils and the patient's body mass index [28]. Several variations of the technique have been proposed with similar outcomes [29]. UPPP has been also shown to be useful to lower CPAP pressure requirements, improving CPAP compliance in certain patients [30].…”

“…Several studies have shown that a MMA is equal in effectiveness to the nasal CPAP. MMA is the modality of surgery with the highest surgical efficacy and cure rate (43 %) [29,43].…”

“…[61] Discussion A commonly used argument against surgery, as a satisfying treatment for OSA, is that is lacks high level scientific data proving its results. Randomized controlled trials (RCT) are considered the highest level of evidence, but they can often pose methodological challenges, particularly in the field of surgery [29,62,63]. For example, it is difficult to justify performing placebo/sham surgical procedures on patients undergoing a general anesthetic.…”

Morphological and Morphometric Analysis of the Hard Palate and the Greater Palatine Foramen in Dry Adult South Indian Skulls

“…Morphometry of the palate forms the fundamental basis for the treatment planning of orthodontic conditions such as orthognathic surgeries, maxillary dental implants, Hemi-maxillectomy, Le Fort fracture management, cleft palate surgery and also useful for preoperative evaluation of patients with uvulopalato pharyngoplasty [2,3]. The proper knowledge of the normal size and structure of this region is needed while performing some meticulous procedures such as Naso pharyngoscopy and nasogastric intubation and also needed for the better designing of instruments [4].…”