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. 2005 Oct 19;2005(4):CD001004.
doi: 10.1002/14651858.CD001004.pub2.

Surgery for obstructive sleep apnoea

S Sundaram  1 , S A Bridgman, J Lim, T J Lasserson
Affiliations

Surgery for obstructive sleep apnoea

S Sundaram et al. Cochrane Database Syst Rev. .

Abstract

Background: Obstructive sleep apnoea/hypopnoea syndrome(OSAHS) is the periodic reduction or cessation of airflow during sleep. The syndrome is associated with loud snoring, disrupted sleep and observed apnoeas. Surgery for obstructive sleep apnoea/hypopnoea syndrome aims to alleviate symptoms of daytime sleepiness, improve quality of life, and reduce the signs of sleep apnoea recorded by polysomnography.

Objectives: The objective of this review was to assess the effects of any type of surgery for the treatment of the symptoms of obstructive sleep apnoea/hypopnoea syndrome in adults.

Search strategy: We searched the Cochrane Airways Group Specialised Register and reference lists of articles. We contacted experts in the field, research dissemination bodies and other Cochrane Review Groups. Searches were current as of July 2005.

Selection criteria: Randomised trials comparing any surgical intervention for obstructive sleep apnoea/hypopnoea syndrome with other surgical or non-surgical interventions or no intervention.

Data collection and analysis: Two reviewers assessed electronic literature search results for possibly relevant studies. Characteristics and data from studies meeting the inclusion criteria were extracted and entered into RevMan 4.2.

Main results: In the 2005 update for this review eight studies (412 participants) of mixed quality met the inclusion criteria. Data from seven studies were eligible for assessment in the review. No data could be pooled. Uvulopalatopharyngoplasty (UPPP) versus conservative management (one trial): An un validated symptom score showed intermittent significant differences over a 12-month follow-up period. No differences in Polysomnography (PSG) outcomes were reported. Laser-assisted uvulopalatoplasty (LAUP) versus conservative management/placebo (two trials): One study recruited mixed a population, and separate data could not be obtained for this trial. In the other study no significant differences in Epworth scores or quality of life reported. A significant difference in favour of LAUP was reported in terms of apnoea hypopnoea index (AHI) and frequency and intensity of snoring. UPPP versus oral appliance (OA) (one trial): AHI was significantly lower with OA therapy than with UPPP. No significant differences were observed in quality of life. UPPP versus lateral pharyngoplasty (lateral PP) (one trial): No significant difference in Epworth scores, but a greater reduction in AHI with lateral PP was reported. Tongue advancement (mandibular osteotomy) + PPP versus tongue suspension + PPP (one trial): There was a significant reduction in symptoms in both groups, but no significant difference between the two surgery types. Complications reported with all surgical techniques included nasal regurgitation, pain and bleeding. These did not persist in the long term. An additional study assessed the effects of four different techniques. No data were available on between group comparisons. Multilevel temperature-controlled radiofrequency tissue ablation (TCRFTA) versus sham placebo and CPAP (one trial): There was an improvement in primary and secondary outcomes of TCRFTA over sham placebo and but no difference in symptomatic improvement when compared with CPAP.

Authors' conclusions: There are now a small number of trials assessing different surgical techniques with inactive and active control treatments. The studies assembled in the review do not provide evidence to support the use of surgery in sleep apnoea/hypopnoea syndrome, as overall significant benefit has not been demonstrated. The participants recruited to the studies had mixed levels of AHI, but tended to suffer from moderate daytime sleepiness where this was measured. Short-term outcomes are unlikely to consistently identify suitable candidates for surgery. Long-term follow-up of patients who undergo surgical correction of upper airway obstruction is required. This would help to determine whether surgery is a curative intervention, or whether there is a tendency for the signs and symptoms of sleep apnoea to re-assert themselves, prompting patients to seek further treatment for sleep apnoea.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 TCRFTA versus sham TCRFTA, Outcome 1 Change from baseline in AHI.
1.2
1.2. Analysis
Comparison 1 TCRFTA versus sham TCRFTA, Outcome 2 Change from baseline in Epworth sleepiness score.
1.3
1.3. Analysis
Comparison 1 TCRFTA versus sham TCRFTA, Outcome 3 Change from baseline in quality of life (Functional Outcome of Sleep Questionnaire).
1.4
1.4. Analysis
Comparison 1 TCRFTA versus sham TCRFTA, Outcome 4 Pain @ 1 week (VAS score).
1.5
1.5. Analysis
Comparison 1 TCRFTA versus sham TCRFTA, Outcome 5 Pain @ 3 weeks (VAS score).
2.1
2.1. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 1 AHI.
2.2
2.2. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 2 Epworth sleepiness score.
2.3
2.3. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 3 Quality of life (sleep apnoea quality of life index).
2.4
2.4. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 4 Snoring intensity (VAS).
2.5
2.5. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 5 Snoring frequency score (VAS).
2.6
2.6. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 6 Withdrawals.
2.7
2.7. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 7 Dysphagia.
2.8
2.8. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 8 Infection.
2.9
2.9. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 9 Bleeding (mild‐severe).
2.10
2.10. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 10 Pain.
2.11
2.11. Analysis
Comparison 2 Laser assisted UP versus conservative management, Outcome 11 Nasal regurgitation.
3.1
3.1. Analysis
Comparison 3 UPPP versus conservative management, Outcome 1 Excessive daytime sleepiness (VAS).
3.2
3.2. Analysis
Comparison 3 UPPP versus conservative management, Outcome 2 Falling asleep when not in bed.
3.3
3.3. Analysis
Comparison 3 UPPP versus conservative management, Outcome 3 ODI4.
3.4
3.4. Analysis
Comparison 3 UPPP versus conservative management, Outcome 4 ODI10.
3.5
3.5. Analysis
Comparison 3 UPPP versus conservative management, Outcome 5 Withdrawals.
3.6
3.6. Analysis
Comparison 3 UPPP versus conservative management, Outcome 6 Dysphagia.
4.1
4.1. Analysis
Comparison 4 Palatal implants versus placebo, Outcome 1 Mean change in AHI.
4.2
4.2. Analysis
Comparison 4 Palatal implants versus placebo, Outcome 2 Mean change in Epworth sleepiness scores.
4.3
4.3. Analysis
Comparison 4 Palatal implants versus placebo, Outcome 3 Change from baseline in quality of life (SF‐36).
4.4
4.4. Analysis
Comparison 4 Palatal implants versus placebo, Outcome 4 Loss to follow‐up.
5.1
5.1. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 1 Apnoea Hypopnea Index.
5.2
5.2. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 2 Quality of life: Vitality.
5.3
5.3. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 3 Quality of life: Contentment.
5.4
5.4. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 4 Quality of life: Sleep.
5.5
5.5. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 5 Oxygen desaturation index.
5.6
5.6. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 6 Withdrawals.
5.7
5.7. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 7 Dysphagia.
5.8
5.8. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 8 Nasopharyngeal regurgitation.
5.9
5.9. Analysis
Comparison 5 UPPP versus oral appliance therapy, Outcome 9 Repeated adjustment.
6.1
6.1. Analysis
Comparison 6 TCRFTA versus CPAP, Outcome 1 Mean change from baseline in Apnoea Hypopnea Index.
6.2
6.2. Analysis
Comparison 6 TCRFTA versus CPAP, Outcome 2 Mean change from baseline in Epworth Sleepiness Score.
6.3
6.3. Analysis
Comparison 6 TCRFTA versus CPAP, Outcome 3 Quality of life (Functional Outcomes of Sleep Questionnaire).
6.4
6.4. Analysis
Comparison 6 TCRFTA versus CPAP, Outcome 4 Withdrawals/loss to follow‐up.
7.1
7.1. Analysis
Comparison 7 UPPP versus lateral PP, Outcome 1 AHI.
7.2
7.2. Analysis
Comparison 7 UPPP versus lateral PP, Outcome 2 Change in AHI from baseline.
7.3
7.3. Analysis
Comparison 7 UPPP versus lateral PP, Outcome 3 Nasal regurgitation.
7.4
7.4. Analysis
Comparison 7 UPPP versus lateral PP, Outcome 4 Withdrawals.
8.1
8.1. Analysis
Comparison 8 Tongue advancement + palatopharyngoplasty versus tongue suspension + palatopharyngoplasty, Outcome 1 Epworth sleepiness scores.
9.1
9.1. Analysis
Comparison 9 RAUP versus submucosal channeling technique, Outcome 1 Reduction in AHI below 10.
9.2
9.2. Analysis
Comparison 9 RAUP versus submucosal channeling technique, Outcome 2 Pain score.
9.3
9.3. Analysis
Comparison 9 RAUP versus submucosal channeling technique, Outcome 3 Dysphagia.
10.1
10.1. Analysis
Comparison 10 Expansion sphincter pharyngoplasty (ESP) versus UPPP, Outcome 1 AHI.
See this image and copyright information in PMC

Update of

Comment in

References

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References to studies awaiting assessment

Lin 2002 {published data only}
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References to ongoing studies

Tommi 2004 {unpublished data only}
    1. Tommi L, Antti M, Maskku P, Jukka Y, Leif B. Radiofrequency induced thermo‐therapy of the soft palate as the treatment of mild sleep apnea syndrome. A prospective placebo‐controlled randomized study. 5th Eurpoean Congress of Oto‐rhino‐laryngology, Head and Neck surgery. 2004:Abstract P261.

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