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Temperature controlled radiofrequency ablation at different sites for treatment of obstructive sleep apnea syndrome: a systematic review and meta-analysis

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Abstract

Background

This study seeks to determine the efficacy of temperature controlled radiofrequency tissue ablation (TCRFTA) to alleviate symptoms of obstructive sleep apnea (OSA) and reduce polysomnographic measures of OSA in the first year post-treatment.

Methods

Systematic review and meta-analysis. Two independent searches of MEDLINE, EMBASE bibliographic databases, and Evidence Based Medicine Reviews to identify publications relevant to OSA and TCRFTA. Effectiveness of TCRFTA was measured separately for application of TCRFTA at the base of tongue and soft palate, and for multilevel intervention using the respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), Epworth sleepiness scale (ESS), and bed partner’s rating of snoring using a visual analogue scale (VAS snoring). The most recent search was conducted in April 2013. Statistical analysis was performed using Review Manager Version 5.2 using a relative measure of effect, i.e., ratio of means (RoM).

Results

Our initial search resulted in 29 eligible studies, and subsequently, 20 studies were included in the meta-analysis. Substantial and consistent improvement in PSG and subjective outcomes were observed post-TCRFTA in the base of tongue (BOT) and multilevel surgery groups only. Application of TCRFTA at the BOT was associated with a significant reduction in RDI (RoM 0.60, CI 0.47–0.76), ESS (RoM 0.59, CI 0.51–0.67), and VAS snoring (RoM 0.48, CI 0.37–0.62) and increase in lowest oxygen saturation (RoM 1.05, CI 1.01–1.10). Similarly, a significant reduction in RDI (RoM 0.61, CI 0.47–0.80) and ESS (RoM 0.79, CI −0.71 to 0.88) was observed after multilevel TCRFTA, but substantial heterogeneity between these studies was observed.

Conclusion

TCRFTA is clinically effective in reducing RDI levels and symptoms of sleepiness in patients with OSA syndrome when directed at the base of tongue or as a multilevel procedure.

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Acknowledgments

We would like to thank Dr. Dwight Patterson (ENT, Western New York Veterans Administration Healthcare System) for his careful review of the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, University at Buffalo, Buffalo, NY, USA

    Ridhwan Y. Baba & V. V. S. Ramesh Metta

  2. Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo and the Western New York Veterans Administration Healthcare system, 3495 Bailey Ave, Buffalo, NY, 14215, USA

    Arjun Mohan & M. Jeffery Mador

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  1. Ridhwan Y. Baba
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Correspondence to M. Jeffery Mador.

Appendix 1

Appendix 1

Search terms used included medical subject headings and the keywords “Catheter Ablation,” “Diathermy,” “Electrocoagulation,” “Sleep Apnea Syndrome,” “Sleep Apnea, Obstructive,” “Sleep disordered breathing,” and “Submucosal Radiofrequency Tongue Ablation” limited to humans. The most recent search was conducted in April 2013.

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Baba, R.Y., Mohan, A., Metta, V.V.S.R. et al. Temperature controlled radiofrequency ablation at different sites for treatment of obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath 19, 891–910 (2015). https://doi.org/10.1007/s11325-015-1125-y

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