Evidence on the surgical management of obstructive sleep apnoea in adults with focus on uvulopalatopharyngoplasty: a scoping review.
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Date
2021
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Abstract
Background: Over the years, various treatment options have been recommended to patients to manage obstructive sleep apnoea (OSA). This study aims to systematically map recent evidence on surgical management of obstructive sleep apnoea in adults with a focus on uvulopalatopharyngoplasty
Methods: This study used a scoping review method guided by Arksey and O’Malley (2005). An electronic database search has been conducted and the databases found were as follows: PubMed, Google Scholar, CINAHL, Health Source, and Medline with full text via EBSCO host. We searched for studies published from 2015 to 2019 that presented evidence on the surgical management of OSA in adults with a focus on UPPP. We screened titles from retrieved studies after completing the database searches and removed duplicates. Two screeners reviewed abstracts and full articles in parallel, guided by eligibility criteria. Emerging themes were extracted from the included studies. The Mixed Method Appraisal Tool (MMAT) 2018 was used to assess the primary studies' quality.
Results: A total of 1,762 articles were identified and screened, of which 16 were included in this review for total data extraction. The studies included collectively reported on oropharyngeal procedures for OSA management, which included modifications to UPPP. All included studies were published between 2015 and 2019. There was limited literature from
LMIC’s. Included studies were conducted in different countries and are as follows: Iran, Egypt, Malaysia, Taiwan, Brazil, Turkey, Italy, Korea, USA, and Germany. Procedures performed as alternatives to UPPP resulted in improved outcomes based on absolute Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale (ESS). Procedures specifically targeting tongue base obstruction or involving tonsillectomy were identified as resulting in better overall outcomes.
Conclusion: UPPP remains a valid surgical option for the management of OSA, but alternative procedures aimed at multi-level approaches, tonsillar obstruction, and relief of tongue-based obstruction are gaining favor. These improved overall outcomes suggest that alternative surgical techniques to UPPP, either alone or in combination with UPPP, should be considered to improve overall postoperative outcomes.
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Masters Degree. University of KwaZulu-Natal, Durban.