Surgery for obstructive sleep apnoea in adults

Background Obstructive sleep apnoea/hypopnoea syndrome(OSAHS) is the periodic reduction or cessation of airflow during sleep. The syndrome is associated with loud snoring, disrupted sleep and observed apnoeas. Surgery for obstructive sleep apnoea/hypopnoea syndrome aims to alleviate symptoms of daytime sleepiness, improve quality of life, and reduce the signs of sleep apnoea recorded by polysomnography. Objectives The objective of this review was to assess the effects of any type of surgery for the treatment of the symptoms of obstructive sleep apnoea/hypopnoea syndrome in adults. Search methods We searched the Cochrane Airways Group Specialised Register and reference lists of articles. We contacted experts in the field, research dissemination bodies and other Cochrane Review Groups. Searches were current as of July 2008. Selection criteria Randomised trials comparing any surgical intervention for obstructive sleep apnoea/hypopnoea syndrome with other surgical or non‐surgical interventions or no intervention. Data collection and analysis Two reviewers assessed electronic literature search results for possibly relevant studies. Characteristics and data from studies meeting the inclusion criteria were extracted and entered into RevMan 5. Main results Twelve studies (709 participants) of mixed risk of bias met the inclusion criteria. Data from ten studies were eligible for assessment in the review. The participants recruited to the studies had mixed levels of AHI, but tended to suffer from moderate daytime sleepiness where this was measured. No data could be pooled. Uvulopalatopharyngoplasty (UPPP) versus conservative management (one trial): An un‐validated 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 (two trials): One study recruited a mixed population and separate data could not be obtained for this trial. 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 (one trial): Within‐treatment group differences were significant for symptoms and AH