Introduction:

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation.

Methods:

The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations.

Results:

The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), increase in lowest oxygen saturation (LSAT), sleep quality, and improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI, and increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, ODI, and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggest that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.

中文翻译：

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将阻塞性睡眠呼吸暂停成人转诊至外科会诊：综述

介绍：

该系统评价为随附的关于将阻塞性睡眠呼吸暂停 (OSA) 成人患者转诊至外科会诊的临床实践指南提供了支持证据。

方法：

美国睡眠医学会委托了一个由睡眠医学专家组成的工作组。进行了系统评价，以确定将使用上呼吸道睡眠呼吸暂停手术或减肥手术与不治疗进行比较的研究，以及报告术前和术后对患者重要和生理结果的研究。进行统计分析以确定使用手术治疗成人阻塞性睡眠呼吸暂停的临床意义。最后，使用推荐分级评估、制定和评估 (GRADE) 过程来评估提出推荐意见的证据。

结果：

文献检索产生了 274 项研究，提供了适合统计分析的数据。分析表明，手术作为抢救疗法可显着降低过度嗜睡、打鼾、血压 (BP)、呼吸暂停-低通气指数 (AHI)、呼吸障碍指数 (RDI)、氧饱和度指数 (ODI)、增加不耐受或不接受气道正压通气 (PAP) 治疗的 OSA 成人患者的最低氧饱和度 (LSAT)、睡眠质量和生活质量改善。分析表明，手术作为辅助治疗可显着降低最佳 PAP 压力，并改善因与高压要求相关的副作用而不能耐受或不接受 PAP 的 OSA 成人患者的 PAP 依从性。分析还表明，手术作为初始治疗可显着降低患有 OSA 和主要解剖学阻塞的成人的 AHI/RDI、嗜睡、打鼾、BP 和 ODI，并增加 LSAT。对减肥手术数据的分析显示，患有 OSA 和肥胖症的成人的血压、AHI/RDI、嗜睡、打鼾、最佳 PAP 水平、BMI、ODI 和 LSAT 增加具有临床意义。对非常有限的证据的分析表明，上呼吸道手术不会导致严重持续不良事件的临床显着增加，并表明减肥手术可能会导致铁吸收不良的临床显着风险，这可以通过补铁来控制。工作组提供了证据的详细摘要以及证据的质量，