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Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis

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Abstract

Objectives

To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries.

Methods

Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE.

Results

351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea–hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of −0.78 (large magnitude of effect) [95% CI −1.06, −0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4–87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports.

Conclusions

Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m2 and non-syndromic children have had the most improvement in AHI. The specific type of surgery must be tailored to the patient. Patients with co-morbidities should undergo treatment in centers that are equipped to provide appropriate perioperative care.

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Author information

Authors and Affiliations

  1. Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, 1 Jarrett White Rd, Honolulu, HI, 96859, USA

    Macario Camacho

  2. School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA

    Michael W. Noller

  3. Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA

    Soroush Zaghi

  4. Division of Otolaryngology and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, Honolulu, HI, USA

    Lauren K. Reckley & Camilo Fernandez-Salvador

  5. John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA

    Erika Ho

  6. University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868, USA

    Brandyn Dunn

  7. Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94158, USA

    Dylan Chan

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  1. Macario Camacho
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  2. Michael W. Noller
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  3. Soroush Zaghi
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Correspondence to Macario Camacho.

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The authors declare that there is no competing interest.

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The Tripler Army Medical Center Investigational Review Board provided approval for this meta-analysis.

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The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

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Camacho, M., Noller, M.W., Zaghi, S. et al. Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 274, 2981–2990 (2017). https://doi.org/10.1007/s00405-017-4545-4

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