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

Macario Camacho; Dongcai Li; Makoto Kawai; Soroush Zaghi; Jeffrey Teixeira; Andrew J Senchak; Scott E Brietzke; Samuel Frasier; Victor Certal

doi:10.1002/lary.25931

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

Laryngoscope. 2016 Sep;126(9):2176-86. doi: 10.1002/lary.25931. Epub 2016 Mar 22.

Authors

Macario Camacho^{1

2}, Dongcai Li³, Makoto Kawai^{4

5}, Soroush Zaghi⁶, Jeffrey Teixeira⁷, Andrew J Senchak⁷, Scott E Brietzke⁷, Samuel Frasier⁸, Victor Certal^{9

10}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii.
² Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, California.
³ Shenzhen Key Laboratory of ENT, Institute of ENT & Longgang ENT hospital, Shenzhen, China, Stanford, California.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, California.
⁵ Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, California.
⁶ Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
⁷ Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
⁸ Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
⁹ Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF & CHEDV Porto, University of Porto, Porto, Portugal.
¹⁰ CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.

PMID: 27005314
DOI: 10.1002/lary.25931

Abstract

Objectives/hypothesis: To 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 design: Systematic review and meta-analysis.

Methods: Nine databases (PubMed/MEDLINE included) were searched through November 24, 2015.

Results: Seventeen 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.

Conclusion: Isolated 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.

Keywords: Tonsillectomy; meta-analysis; obstructive sleep apnea; sleep apnea syndromes; systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adult
Humans
Sleep Apnea, Obstructive / surgery*
Tonsillectomy*