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The influence of position-dependency on surgical success in sleep apnea surgery — a systematic review

  • Sleep Breathing Physiology and Disorders • Review
  • Published:
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Abstract

Purpose

To evaluate the influence of position-dependency on surgical success of upper airway (UA) surgery in obstructive sleep apnea (OSA) patients.

Methods

Systematic review.

Results

Two prospective cohort studies and seven retrospective cohort studies were included in this review. Despite the importance of the subject, it remains unclear whether position-dependency is a predictor for surgical success. No differences were found in surgical success rate between non-positional (NPP) and positional (PP) OSA patients undergoing uvulopalatopharyngoplasty/Z-palatoplasty with or without radiofrequent thermotherapy of the tongue, isolated tongue base or multilevel surgery and hypoglossal nerve stimulation. In one study PP undergoing relocation pharyngoplasty had a greater chance of surgical success. In the majority of the remaining studies, surgical success was in favor of NPP. Furthermore, in the vast part of included studies, the effect of UA surgery was suggested to be greater in the lateral position than supine position.

Conclusion

Although preoperative characteristics in PP (e.g., lower BMI and AHI) seem to be in favor for higher surgical success compared to NPP, it remains unclear whether position-dependency is a predictor for surgical outcome. It is suggested that the largest differences and expected preoperative and postoperative changes occur in non-supine AHI. In PP, the preoperative non-supine AHI is already lower compared to NPP suggesting a lower chance of surgical success in PP.

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    P. E. Vonk, P. J. Rotteveel, M. J. L. Ravesloot & N. de Vries

  2. Department of Otorhinolaryngology, Medical Centre Jan van Goyen, Amsterdam, The Netherlands

    M. J. L. Ravesloot

  3. Department of Research and Education, Medical Library, OLGV, Amsterdam, The Netherlands

    C. den Haan

  4. Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands

    N. de Vries

  5. Department of Otorhinolaryngology — Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium

    N. de Vries

Authors
  1. P. E. Vonk
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  2. P. J. Rotteveel
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  3. M. J. L. Ravesloot
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  4. C. den Haan
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  5. N. de Vries
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Corresponding author

Correspondence to P. E. Vonk.

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Conflict of interest

N. de Vries is a member of the Medical Advisory Board of NightBalance and has shares in NightBalance. He is also an investigator of Inspire and Jazz Pharmaceutics, consultant of Philips, Olympus and the AE Mann Foundation and has inventor patent on PCT/US2010/062576 including devices, systems, and methods for monitoring sleep position. All other authors declare that they have no conflicts of interest or financial ties to disclose.

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Vonk, P.E., Rotteveel, P.J., Ravesloot, M.J.L. et al. The influence of position-dependency on surgical success in sleep apnea surgery — a systematic review. Sleep Breath 24, 433–442 (2020). https://doi.org/10.1007/s11325-019-01935-y

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  • DOI: https://doi.org/10.1007/s11325-019-01935-y

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