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Systematic Review of the Effect of Upper Airway Surgery based on DISE findings in Adults with Obstructive Sleep Apnea

Author(s): Bertelsen JB, Ovesen T, Zainali-Gill K.

Introduction: Obstructive sleep apnea (OSA) is common among adults worldwide and is associated with an increased risk of both cardiac, metabolic, and mental disease and an increased risk of traffic accidents. However, evidence of the different types of upper airway surgery to relieve OSA symptoms is sparse. Whether Drug induced sedation endoscopy (DISE) can improve the outcome of the various surgical techniques in the upper airways (UA) is uncertain. The objective of this review was to evaluate the effectiveness of UA surgery in adults with OSA by change in apnea-hypopnea index (AHI) with minimum three months follow-up in studies where DISE was used.

Methods: Cochrane, PubMed, CINAHL and Embase were systematically searched on March the 22nd 2022. Relevant studies were selected on abstracts and full texts were obtained for critical appraisal. Relevant data was extracted for data synthesis. The reference list of all studies selected for critical appraisal was screened for additional studies. Studies included were randomized controlled trials, prospective and retrospective studies, casecontrol studies and cohort studies of one or a combination of surgeries on the upper airways in adults diagnosed with OSA and obstruction verified by DISE before surgery published from January 1st 2000 to 31th of December 2021. AHI was reported prior to and minimum three months after surgery by polysomnography or home sleep apnea test and a minimum of 40 participants were included. Surgery in the upper airways such as soft tissue of the retropharyngeal space, velum, tonsils and base of tongue (BOT) were included. Cartilage and osseous surgery as septoplasty, turbinoplasty, mandibular advancement surgery, epiglottoplasty and tracheostomy were included plus studies of hypoglossal nerve stimulation implant insertion.

Results: Studies were

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