Hypopharyngeal surgery in obstructive sleep apnea - An evidence-based medicine review

Objective: To perform an evidence-based medicine review of the literature describing outcomes of hypopharyngeal surgery in obstructive sleep apnea. Design: We performed a MEDLINE search of English-language articles or abstracts using the keywords sleep and surgery in combination with any of the following terms: hypopharynx, tongue, tongue base, epiglottis, genioglossus, advancement, mortised, genioplasty, glossectomy, tongue radiofrequency, hyoepiglottoplasty, hyoid, suspension, and stabilization. Additional studies were identified from their reference lists. We reviewed abstracts to select publications reporting outcomes of hypopharyngeal surgery in obstructive sleep apnea. Articles were included only if patients underwent treatment of the palate for suspected retropalatal obstruction. Data Extraction: Evidence-based medicine review for level of evidence, preoperative patient characteristics, surgical outcomes, and patient-specific factors associated with outcomes. Results: We identified 36 articles. These were primarily case series studies (level 4 evidence), although some studies provided levels 1 and 2 evidence. Hypopharyngeal surgery demonstrates improvements in respiratory physiology during sleep, daytime somnolence, and quality of life. Several factors such as the body mass index, apnea-hypopnea index, Friedman stage, and SNB angle on lateral cephalogram have been associated with surgical outcomes. Considering the improvement in respiratory physiology alone, successful outcomes are achieved in 35% to 62% of patients; certain subgroups achieve higher success rates. Conclusions: Hypopharyngeal surgery in obstructive sleep apnea is associated with improved outcomes, although this benefit is supported largely by level 4 evidence. Future research should include larger, higher-level studies that consider the variety of treatment effects, compare surgical treatments, and identify factors associated with outcomes.