Tracheostomy as treatment for adult obstructive sleep apnea: a systematic review and meta-analysis.

Abstract

OBJECTIVES/HYPOTHESIS:

To systematically review outcomes for polysomnography, sleepiness, and mortality in patients who undergo tracheostomy for the treatment of adult obstructive sleep apnea (OSA).

DATA SOURCES:

MEDLINE, Scopus, and the Cochrane Library were searched from inception to March 2013, followed by extensive hand searching for the identification of relevant English language studies that met predefined criteria.

REVIEW METHODS:

Adult studies of tracheostomies or tracheotomies as treatment for OSA with outcomes for apnea index (AI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), effect on daytime sleepiness or mortality were identified, abstracted and pooled (as appropriate). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

RESULTS:

The systematic search identified 18 relevant studies that were primarily case series, using retrospective review. Posttracheostomy AI improved from 73.0 ± 27.1 to 0.2 ± 1.2/h and an AI mean difference of -83.47 (95% CI, -106.07 to -60.87; P < 0.0001). Mean AHI decreased from 92.0 ± 34.8 to 17.3 ± 20.5/h and an AHI mean difference -79.82 (95% CI, -63.74 to -95.90; P < 0.0001) compared with preoperative status was observed. Postsurgically, there was a development of central apneas; however, the central AI demonstrated near normalization to a mean of 2.1 ± 3.5/h after 14 weeks. ODI decreased from 78.2 ± 25.8/h to 20.8 ± 25.5/h. Four studies demonstrated a statistically significant improvement in subjective sleepiness posttracheostomy. Postoperative statistically significant reductions in overall and in cardiovascular mortality compared with untreated historical cohorts was reported.

CONCLUSION:

Tracheostomies significantly decrease apnea index, oxygen desaturation index, sleepiness, and mortality in OSA subjects.

• Authors: Macario Camacho, Victor Certal, Scott E Brietzke, Jon-Erik C Holty, Christian Guilleminault, Robson Capasso
• Journal: The Laryngoscope (Laryngoscope) Vol. 124 Issue 3 Pg. 803-11 (Mar 2014) ISSN: 1531-4995 [Electronic] United States
• PMID: 24549987 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Topics

• Adult
• Aged
• Female
• Humans
• Male
• Middle Aged
• Oxygen Consumption (physiology)
• Polysomnography (methods)
• Prognosis
• Pulmonary Gas Exchange
• Quality of Life
• Risk Assessment
• Severity of Illness Index
• Sleep Apnea, Obstructive (diagnosis, mortality, surgery)
• Survival Rate
• Tracheostomy (methods)
• Treatment Outcome