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Cited by 541Obstructive Sleep Apnea ResearchAirway Management and Intubation TechniquesSleep and related disorders

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

Open access
Caples, Sean M., Rowley, James A., Prinsell, Jeffrey R., Pallanch, John F., Elamin, Mohamed B., Katz, Sheri G., Harwick, John D.·2010·Sleep
DOI 10.1093/sleep/33.10.1396PMC PMC2941427
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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.

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Crossref · 10.1093/sleep/33.10.1396

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106 of 106 references verified0 citation errors · 0 not checkable

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  • Outcomes that determine durability include symptoms, somnographic variables, and comorbidities, and these are not uniformly examined across the literature.

    “Outcomes that determine durability of treatment include symptoms, somnographic variables, and comorbidities. These parameters are not uniformly examined across the literature when assessing for long-term response.1686”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1686]

    The Data Collection section (p. 2) lists follow-up, polysomnographic measures, and symptoms among the information extracted. The Conclusions (p. 10) say sleep-study methods were not standardized and data on non-respiratory outcomes and cardiovascular or systemic interactions were sparse. These passages support uneven assessment of relevant outcomes, but do not specifically establish that all three categories determine durability or describe their assessment in long-term follow-up. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • MMA can be highly effective as either primary or second-line surgery.

    “However, MMA can be highly effective as either primary or second-line surgery.1686,2007”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1686]

  • Palatal surgeries do not consistently reduce AHI, even in mild to moderate OSA.

    “Palatal surgeries, one of the most commonly performed OSA surgeries, have a reputation for not consistently lowering AHI even in mild to moderate OSA.1686”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1686]

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Research works printed but not linked: 2

  1. [25]25. Dekeister C, Lacassagne L, Tiberge M, Montemayor T, Migueres M, Paoli JR. [Mandibular advancement surgery in patients with severe obstructive sleep apnea uncontrolled by continuous positive airway pressure. A retrospective review of 25 patients between 1998 and 2004]. Revue des maladies respiratoires 2006;23(5 Pt 1):430-37.
  2. [27]27. illofacial procedures for the treatment of sleep apnea: comparison of subjective and objective results. J Oral Maxillofac Surg 2004;62:164-8.

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Authors
Caples, S. M., Rowley, J. A., Prinsell, J. R., Pallanch, J. F., Elamin, M. B., Katz, S. G., & Harwick, J. D.
Affiliations
  • Mayo Clinic (US)
  • Harper University Hospital (US)
  • University of Florida (US)
ORCID
Rowley, James A.
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2010-10
Volume
33
Issue
10
Pages
1396-1407
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/33.10.1396
PMC
PMC2941427
OpenAlex
W186138225
Semantic Scholar
4ed89f23ce3c6be9bafb9de2e0708dd64608920c
Cited by
541
References
106
Citations by year
2026: 16 · 2025: 28 · 2024: 19 · 2023: 21 · 2022: 39 · 2021: 39 · 2020: 42 · 2019: 31 · 2018: 40 · 2017: 45 · 2016: 45 · 2015: 37 · 2014: 45 · 2013: 33 · 2012: 33
FWCI
2.99
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Mayo Clinic
  • ResMed
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
obstructive sleep apnea, upper airway surgery, maxillomandibular advancement, laser-assisted uvulopalatoplasty, radiofrequency ablation, apnea-hypopnea index, surgical outcomes, adverse events, patient selection, adults
MeSH terms
Adult, Female, Humans, Male, Middle Aged, Palate, Soft, Pharynx, Uvula, Treatment Outcome, Catheter Ablation, Mandibular Advancement, Sleep Apnea, Obstructive, Laser Therapy

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