Surgery for Obstructive Sleep Apnoea

A Cochrane review [Abstract] 1 included 12 studies with a total of 709 subjects.

• Uvulopalatopharyngoplasty (UPPP) versus conservative management (1 trial): An unvalidated 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 (2 trials): One study recruited a mixed a population. 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.
• Palatal implants versus placebo (one trial): Symptoms and AHI were lower with palatal implants.
• LAUP versus bipolar radiofrequency volumetric tissue reduction (1 trial): Within-treatment group differences were significant for symptoms and AHI, but the between treatment group differences were not available to assess whether indirect inferences could be made regarding the effects of either treatment.
• UPPP versus oral appliance (OA; 1 trial): AHI was significantly lower with OA therapy than with UPPP. No significant differences were observed in quality of life.
• UPPP versus lateral pharyngoplasty (1 trial): No significant difference in Epworth scores, but a greater reduction in AHI with lateral PP was reported.
• Expansion sphincter pharyngoplasty (one trial): Both interventions reduced AHI although statistical analysis on the difference between treatments was not reported.
• Tongue advancement (mandibular osteotomy) + PPP versus tongue suspension + PPP (1 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 (1 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.
• Radiofrequency assisted uvulopalatoplasty technique versus channeling technique (one trial): Dysphagia scores were lower in the channeling group immediately post-operation, but at four months the difference was no longer significant. Snoring scores did not differ at long-term follow-up. The number of participants achieving AHI lower than 10 at four months was slightly higher with RAUP than channeling technique.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by inconsistency (heterogeneity in interventions and outcomes).

References

• Sundaram S, Lim J, Lasserson TJ. Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev 2005 Oct 19;(4):CD001004 [Review content assessed as up-to-date: 30 June 2008]. [PubMed]