Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis

被引：67

作者：

Camacho, Macario ^{[1
,2
]}

Li, Dongcai ^{[3
,4
]}

Kawai, Makoto ^{[5
,6
,7
]}

Zaghi, Soroush ^{[8
]}

Teixeira, Jeffrey ^{[9
]}

Senchak, Andrew J. ^{[9
]}

Brietzke, Scott E. ^{[9
]}

Frasier, Samuel ^{[10
]}

Certal, Victor ^{[11
,12
]}

机构：

[1] Tripler Army Med Ctr, Div Sleep Surg & Med, Dept Otolaryngol Head & Neck Surg, 1 Jarrett White Rd, Honolulu, HI 96859 USA

[2] Stanford Hosp & Clin, Sleep Med Div, Dept Psychiat & Behav Sci, Stanford, CA USA

[3] Inst ENT, Shenzhen Key Lab ENT, Shenzhen, Peoples R China

[4] Longgang ENT Hosp, Shenzhen, Peoples R China

[5] Stanford Univ, Sch Med, Dept Psychiat & Behav Sci, Stanford, CA 94305 USA

[6] VA Palo Alto Hlth Care Syst, Sierra Pacific Mental Illness Res Educ Ctr, Palo Alto, CA USA

[7] VA Palo Alto Hlth Care Syst, Sierra Pacific Mental Illness Clin Ctr, Palo Alto, CA USA

[8] Univ Calif Los Angeles, David Geffen Sch Med, Dept Head & Neck Surg, Los Angeles, CA 90095 USA

[9] Walter Reed Natl Mil Med Ctr, Dept Otolaryngol Head & Neck Surg, Bethesda, MD USA

[10] Naval Med Ctr Portsmouth, Dept Otolaryngol Head & Neck Surg, Portsmouth, VA USA

[11] Hosp CUF & CHEDV Porto, Dept Otorhinolaryngol, Sleep Med Ctr, Oporto, Portugal

[12] Univ Porto, CINTESIS Ctr Res Hlth Technol & Informat Syst, Oporto, Portugal

来源：

LARYNGOSCOPE | 2016年 / 126卷 / 09期

关键词：

Tonsillectomy; obstructive sleep apnea; sleep apnea syndromes; meta-analysis; systematic review; NASAL SURGERY; UPPER AIRWAY; HYPERTROPHY; TONSIL; TRACHEOSTOMY; PARAMETERS; MANAGEMENT; NOSE; CARE;

D O I：

10.1002/lary.25931

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

Objectives/HypothesisTo determine if sleepiness and sleep study variables (e.g., Apnea-Hypopnea Index [AHI] and lowest oxygen saturation) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA). Study DesignSystematic review and meta-analysis. MethodsNine databases (PubMed/MEDLINE included) were searched through November 24, 2015. ResultsSeventeen studies (n = 216 patients, 34.4 10.0 years and body mass index: 29.0 +/- 6.1 kg/m(2)) met criteria. Tonsils sizes were hypertrophied, large, enlarged, extremely enlarged, or grades 2 to 4. Apnea-Hypopnea Index decreased by 65.2% (from 40.5 +/- 28.9/hour to 14.1 +/- 17.1/hour) (n = 203). The AHI mean difference (MD) was -30.2 per hour (95% confidence interval [CI] -39.3, -21.1) (P value < 0.00001). The AHI SMD was -1.37 (-1.65, -1.09) (large effect). Lowest oxygen saturation improved from 77.7 +/- 11.9% to 85.5 +/- 8.2% (n = 186). Lowest oxygen saturation MD was 8.5% (95% CI 5.2, 11.8) (P value < 0.00001). The Epworth Sleepiness Scale decreased from 11.6 +/- 3.7 to 6.1 +/- 3.9 (P value < 0.00001) (n = 125). Individual patient outcomes (n = 54) demonstrated an 85.2% success rate (AHI < 20/hour and 50% reduction) and a 57.4% cure rate. Individual patient data meta-analysis showed preoperative AHI < 30 per hour to be a significant predictor of surgical success (P value < 0.001) and cure (P value = 0.043); among patients with preoperative AHI < 30 per hour, tonsillectomy success rate was 100% (25 of 25) and cure rate was 84% (21 of 25) with a mean postoperative AHI of 2.4 +/- 2.1 per hour; this compares to tonsillectomy success rate of 72.4% (21 of 29), cure rate of 10 of 29 (34.4%), and mean postoperative AHI of 14.3 +/- 13.9 per hour for patients with preoperative AHI 30 per hour. ConclusionIsolated tonsillectomy can be successful as treatment for adult OSA, especially among patients with large tonsils and mild to moderate OSA (AHI < 30/hour). Laryngoscope, 2016 Laryngoscope, 126:2176-2186, 2016

引用

页码：2176 / 2186

页数：11

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