TABLE 17

Studies Providing an Estimate of the Proportion of Patients Who Were Cured of OSAS With Surgery

SourceYearLevelNo.Age, y PopulationPolysomnographic Criterion for SurgeryOperationFollow-up Period, moSubjects Who Had OSAS at Follow-upMiscellaneous
General population studies
 Chervin et al372006I395.0–12.9AHI ≥1AT13 ± 1.421%2 articles documented findings in the same population
 Dillon et al275
 Guilleminault et al1352004III561.25–12.5AHI ≥1 or RDI >2AT: 36 (some of whom also had nasal turbinectomy and/or tonsillar wound suturing); A: 8; T: 113AT: 19.4%; A: 100%; T: 100%Half of AT failures were in obese patients
 Guilleminault et al1412007III1991.5–14AHI ≥1AT in 183; A or T in 19; nasal turbinectomy in 17.4%3–546.2%Increased nasal turbinate score, presence of deviated nasal septum and increased Mallampati score of relationship of tongue to uvula and retro position of the mandible were all predictive of higher failure rate
 Guilleminault et al2762004IV2842–12.1AHI >1.5AT in 228; A or T inferior turbinectomy in 733–48.8% of those with preoperative AHI <10 and AT; 64.7% of those with preoperative AHI ≥10. No breakdown provided regarding results of AT versus other surgeryAn additional 99 children had RDI >1.5 and AHI <1.5. Of this group, 100% had normal RDI after AT and 9.2% had residual abnormal RDI after A or T. Difficult to interpret findings because of inconsistent reporting of data
 Mitchell1322007III793–14AHI ≥5AT1–9.316% (AHI ≥5); 29% (AHI >1.5)Severity of preoperative AHI predicted response: preoperative 5–10, 0% ≥5; preoperative 10–20, postoperative 12% ≥5; preoperative >20, postoperative 36% ≥5; 13/22 with postoperative snoring had AHI ≥5; 0/57 without postoperative snoring had AHI ≥5
 Tal et al2772003IV361.8–12.6RDI >1AT4.6 (1–16)11.11% had RDI >5
 Tauman et al1372006III1106.4 ± 3.9AHI ≥1AT1–1546% AHI 1–5, 29% with AHI >5In logistic regression, AHI before surgery and family history of OSAS were significant predictors of AHI >5 postoperative
 Walker et al2782008IV340.93–5RDI >5 in REM sleepAT9.835% with RDI >5Treatment failures limited to those with preoperative RDI in REM >30
 Bhattacharjee et al1332010III5786.9 ± 3.8AHI ≥1AT1–2472.8% with AHI ≥1; 21.6% >5Large multicenter study. Age >7 y, increased BMI, presence of asthma, and high preoperative AHI were independent predictors of persistent postoperative OSAS
 Brietzke and Gallagher1302006III3254.9VariousAHI ≥1AT3.317.1% (depended on OSAS criteria for each study)Meta-analysis of 11 case series published between 1980 and 2004
Ye et al1342010IV847.1 ± 3.2ChineseAHI ≥5AT18–2331% with AHI ≥1; 13.1% with AHI ≥5Obesity and high preoperative AHI were significant independent predictors of treatment failure
Focus on obese populations
 Mitchell and Kelly2792004III303.0–17.2Obese (BMI >95th percentile)AHI >5AT5.654%
 Mitchell and Kelly1392007III723–18Comparison of obese (BMI >95th percentile) with nonobeseAHI ≥2: AHI 2–5 mild, AHI 5–15 moderate AHI ≥15 severeAT5–6Obese: 76%: (46% mild; 15% moderate; 15% severe). Nonobese: 28%: (18% mild; 10% moderate).Preoperative AHI and obesity were independent risk factors for postoperative OSAS. OR for persistent OSAS in obese, adjusted for preoperative AHI, was 3.7 (95% CI: 1.3–10.8)
 O’Brien et al1362006III697.1 ± 4.2Obese (weight >2 SDs from mean for age)RDI ≥5AT20.4 ± 16.8Nonobese: 22.5%; Obese: 55%Preoperative AHI and obesity were independent risk factors for postoperative OSAS. OR for persistent OSAS in obese, adjusted for preoperative AHI, was 4.7 (95% CI: 1.7–11.2)
 Shine et al1942006IV196.5 ± 4.4Obese (BMI >95th percentile)RDI>518 AT (1 with UPPP), 1 T2–663%Missing data
 Costa and Mitchell1312009III1107.3–9.3ObeseVariousAT3–5.788% had postoperative AHI ≥1; 75% had postoperative AHI ≥2; 51% had postoperative AHI ≥5Meta-analysis of 4 obesity studies included here
 Apostolidou et al1382008IV706.5 ± 2.2Greek; obese defined as >1.645 SDs from mean weight for ageOAHI ≥1AT2-14Overall: 75.7% with AHI ≥1 (77.3% obese, 75% nonobese). Among children with a preoperative OAHI ≥5: 9% with AHI ≥5 (8% obese, 10% nonobese)
Focus on other special populations
 Mitchell and Kelly1402005III201.1–3.0Children <3 yRDI >5AT4.1–20.465%: 25% RDI 5–10; 25% RDI 10–20; 15% RDI >20Included comorbidities (Down syndrome, cardiac disease, cerebral palsy) excluded from this guideline. 60% of patients were severe, with RDI >20 at baseline
 Mitchell and Kelly2802004III291.4–17Severe OSASRDI >5; severe: RDI ≥30AT669% with postoperative RDI >548% were obese
  • A, adenoidectomy; CI, confidence interval; OAHI, obstructive AHI; OR, odds ratio; T, tonsillectomy; REM, rapid eye movement; UPPP, uvulopharyngopalatoplasty.