Multilevel Palate and Tongue Base Surgical Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta‐analysis
Graeme B. Mulholland MD, FRCSC  Caroline C. Jeffery MD, FRCSC  Hedyeh Ziai MD  Varinder Hans BSc  Hadi Seikaly MD, FRCSC  Kenny P. Pang FRCSEd, FRCSI(OTO)  Brian W. Rotenberg MD, FRCSC
First published: 25 March 2019 https://doi.org/10.1002/lary.27597
This work was supported by the Alberta SPOR SUPPORT Unit at the University of Alberta for statistical work on the meta‐analysis.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objective
To evaluate multilevel palate and tongue base surgery as a method of treatment of obstructive sleep apnea by comparing the pre‐ and postoperative apnea‐hypopnea index.

Methods
We conducted a systematic review. MEDLINE and Embase databases were searched in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for conducting systematic reviews. Two authors screened all articles and performed methodological quality assessment. Relevant articles where reviewed in detail. Standard inclusion criteria were applied for article selection. Relevant data were extracted and summarized, a difference of means random‐effects model was performed. Our primary outcome measure was change in apnea‐hypopnea index pre‐/postsurgical treatment.

Results
Of 1,172 studies identified from January 2006 to March 2017, 46 studies met inclusion criteria and were included in the systematic review. This included 11 surgical subgroups and 1,806 patients. Methodological quality and risk of bias assessments were completed. There was strong male predominance 86.8 (standard deviation [SD] = 10.3%), and the average age was 46.8 (SD = 4.0) years. All studies included overweight to obese patients (average body mass index = 29.1 [SD = 3.5]). The average preoperative apnea‐hypopnea index was 39.0 (SD = 15.4), and the average postoperative apnea‐hypopnea index decreased to 18.3 (SD = 7.5). Meta‐analysis data yielded a decrease in apnea‐hypopnea index of −23.67 with a 95% confidence interval of −27.27 to −20.06.

Conclusions
Non–maxillomandibular advancement, multilevel surgical procedures for obstructive sleep apnea demonstrate significant improvements in reduction of apnea‐hypopnea index following surgery in addition to improvement in many other sleep‐specific outcomes. Future research should include larger, higher‐level studies that compare surgical treatments and identify factors associated with outcomes.

Level of Evidence
NA

Laryngoscope, 129:1712–1721, 2019