Systematic review and updated meta-analysis of multi-level surgery for patients with OSA

Auris Nasus Larynx. 2022 Jun;49(3):421-430. doi: 10.1016/j.anl.2021.10.001. Epub 2021 Nov 1.


Objectives: To perform an updated systematic review for determining the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea/hypopnea syndrome (OSA).

Methods: A systematic review was performed to identify English-language studies that evaluated the treatment of adult OSA patients with multilevel OSA surgery up to January, 2018. We used polysomnography as a metric of treatment success. Articles were only included if the surgery intervention involved at least two of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Eighty-seven studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success.

Results: The meta-analysis included 3931 subjects with a mean age of 46.1 years. The originally reported success rate in the included literature was 59.9%. A meta-analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria - namely "a reduction in apnea/hypopnea index (AHI, /hr.) of 50% or more and an AHI of less than 20". The recalculated success rate was 60.2%. Standard meta-analytic techniques for combining p-values between studies after weighting for sample size found significant improvements in AHI, apnea index, % of rapid eye movement sleep, lowest saturation of oxygen (%), and Epworth Sleepiness Scale.

Conclusion: This study shows the significant improvement of treatment outcomes with multilevel surgery for OSA patients.

Keywords: Obstructive sleep apnea/hypopnea syndrome; Snoring; Treatment outcomes; Upper airway surgery.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Humans
  • Middle Aged
  • Oxygen
  • Polysomnography
  • Sleep Apnea, Obstructive* / surgery
  • Treatment Outcome


  • Oxygen