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Uvulopalatopharyngoplasty with or without tonsillectomy in the treatment of adult obstructive sleep apnea – A systematic review
- Source :
- Stuck, B A, Ravesloot, M J L, Eschenhagen, T, de Vet, H C W & Sommer, J U 2018, ' Uvulopalatopharyngoplasty with or without tonsillectomy in the treatment of adult obstructive sleep apnea – A systematic review ', Sleep Medicine, vol. 50, pp. 152-165 . https://doi.org/10.1016/j.sleep.2018.05.004, https://doi.org/10.1016/j.sleep.2018.05.004
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background The most commonly performed surgical procedure for obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty with or without tonsillectomy (UPPP ± TE). However, there is currently no review solely focusing on clinically relevant effects of standard UPPP technique with or without tonsillectomy as a monotherapy in patients with OSA. Methods A systematic review and meta-analysis were performed to assess the effects of isolated UPPP ± TE in patients with OSA. Studies of any design referring to adult patients with obstructive sleep apnea diagnosed via polysomnography or comparable objective measures were considered, in which isolated “standard” UPPP ± TE was performed. Results Forty-eight studies were included for the qualitative analysis. All but one study demonstrated a reduction in the frequency of respiratory events and success/response rates ranged from 35 to 95.2%. In the six studies that reported pre- and postoperative mean scores of the Epworth Sleepiness Scale (ESS), a reduction in sleepiness scores was demonstrated. Data addressing the effect of UPPP ± TE in comparison to no treatment or control were available from two randomized controlled trials (RCT). When pooling the data, UPPP ± TE was significantly more effective in reducing the apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) (large effect): an AHI mean difference (MD) of −18.59 (95% CI −34.14, −3.04) and an ESS MD of −5.37 (95% CI −7,03, −3.72). Data addressing effect of UPPP ± TE in comparison to baseline was available from three RCT. When pooling the data, the AHI was reduced from a mean 35.4 to 17.9 (49.5% reduction); a MD of −20.41, 95% CI −32.78, −8.04 (−1.80, −1.15) (large effect). Various additional beneficial effects of UPPP ± TE were demonstrated including improvement in sexual function, ventricular function, sleep stages, serum lipid, depressive disorder and driving performance. Conclusion UPPP ± TE reduces respiratory events and daytime sleepiness in adult patients with OSA and UPPP ± TE is superior to non-treated controls in this regard. Further research is needed to establish the long-term benefit, the impact on cardiovascular morbidity and the role of UPPP ± TE in the variety of available treatment options for OSA.
- Subjects :
- medicine.medical_specialty
Polysomnography
medicine.medical_treatment
law.invention
03 medical and health sciences
0302 clinical medicine
stomatognathic system
Randomized controlled trial
law
Internal medicine
medicine
Humans
Postoperative Period
030223 otorhinolaryngology
Tonsillectomy
Sleep Apnea, Obstructive
Sleep Stages
medicine.diagnostic_test
business.industry
Epworth Sleepiness Scale
Uvulopalatopharyngoplasty
Sleep apnea
General Medicine
Plastic Surgery Procedures
medicine.disease
respiratory tract diseases
Obstructive sleep apnea
Treatment Outcome
Uvula
Pharynx
Palate, Soft
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 13899457
- Volume :
- 50
- Database :
- OpenAIRE
- Journal :
- Sleep Medicine
- Accession number :
- edsair.doi.dedup.....eaad70c58a5982c7b95e7ce7ad377973