Effectiveness of Palatopharyngeal Surgery Modifications in Obstructive Sleep Apnea: A Meta-analysis.

Abstract

Objective: The effectiveness of various palatopharyngeal surgeries is currently poorly understood. This study compares various palatopharyngeal surgery techniques without tonsillectomy for reducing the apnea-hypopnea index (AHI).

Data sources: Embase, MEDLINE, Web of Science, ClinicalTrials, CINAHL, the Cochrane Library, and International Clinical Trials Registry Platform.

Review methods: We included studies of palatopharyngeal surgery in adults reporting AHI outcomes, excluding those with tonsillectomy or combined surgeries. A random-effects model was used to pool effect sizes. Surgical techniques were categorized into cold steel, muscle relocation, suture, radiofrequency, laser, powered instruments, and implants. The primary outcome was the reduction in AHI. Secondary outcomes were the AHI responder rate, AHI reduction over the follow-up duration, and the outcomes by publication year.

Results: From 3793 screened records, 45 studies with 1501 patients were included. Overall, palatopharyngeal surgery reduced AHI by 5.2/h (95% CI, 2.7-7.7; P < .0001). Powered instruments showed the greatest AHI reduction (26.3/h; 95% CI, 18.9-33.7), followed by muscle relocation (20.2/h; 95% CI, 3.7-36.7) and suture techniques (15.3/h; 95% CI, 9.6-21.0). Palatal implants (2.6/h; 95% CI, 0.4-4.7) and laser techniques (4.5/h; 95% CI, 1.3-7.8) showed modest effects, whereas radiofrequency (0.4/h; 95% CI, -2.0 to 2.8) and cold steel (6.6/h; 95% CI, -0.2 to 13.5) had no significant impact. The overall responder rate was 51% (95% CI, 41-60), with powered instruments, relocation, and suture techniques demonstrating the highest rates.

Conclusion: Palatopharyngeal surgery techniques significantly differ in reducing AHI. Powered instruments, muscle relocation, and suture techniques are most effective.

Trial registration: PROSPERO identifier: CRD42024559063.