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|Title:||Tracheostomy as treatment for adult obstructive sleep apnea: a systematic review and meta-analysis.|
|Authors:||Camacho, Macario;Certal, Victor;Brietzke, Scott E;Holty, Jon-Erik C;Guilleminault, Christian;Capasso, Robson|
|Keywords:||Adult;Aged;Female;Human;Male;Middle Aged;Oxygen Consumption;Oxygen Consumption: physiology;Polysomnography;Polysomnography: methods;Prognosis;Pulmonary Gas Exchange;Quality of Life;Risk Assessment;Severity of Illness Index;Sleep Apnea, Obstructive;Sleep Apnea, Obstructive: diagnosis;Sleep Apnea, Obstructive: mortality;Sleep Apnea, Obstructive: surgery;Survival Rate;Tracheostomy;Tracheostomy: methods;Treatment Outcome|
|Abstract:||OBJECTIVES/HYPOTHESIS: To systematically review outcomes for polysomnography, sleepiness, and mortality in patients who undergo tracheostomy for the treatment of adult obstructive sleep apnea (OSA).\n\nDATA SOURCES: MEDLINE, Scopus, and the Cochrane Library were searched from inception to March 2013, followed by extensive hand searching for the identification of relevant English language studies that met predefined criteria.\n\nREVIEW METHODS: Adult studies of tracheostomies or tracheotomies as treatment for OSA with outcomes for apnea index (AI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), effect on daytime sleepiness or mortality were identified, abstracted and pooled (as appropriate). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.\n\nRESULTS: The systematic search identified 18 relevant studies that were primarily case series, using retrospective review. Posttracheostomy AI improved from 73.0 ± 27.1 to 0.2 ± 1.2/h and an AI mean difference of -83.47 (95% CI, -106.07 to -60.87; P < 0.0001). Mean AHI decreased from 92.0 ± 34.8 to 17.3 ± 20.5/h and an AHI mean difference -79.82 (95% CI, -63.74 to -95.90; P < 0.0001) compared with preoperative status was observed. Postsurgically, there was a development of central apneas; however, the central AI demonstrated near normalization to a mean of 2.1 ± 3.5/h after 14 weeks. ODI decreased from 78.2 ± 25.8/h to 20.8 ± 25.5/h. Four studies demonstrated a statistically significant improvement in subjective sleepiness posttracheostomy. Postoperative statistically significant reductions in overall and in cardiovascular mortality compared with untreated historical cohorts was reported.\n\nCONCLUSION: Tracheostomies significantly decrease apnea index, oxygen desaturation index, sleepiness, and mortality in OSA subjects.|
|More Information:||Volume : 124Issue : 3Start page : 803|
END PAGES : 11
|Appears in Collections:||Laryngoscope|
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