Abstract

Background

Laser-assisted uvulopalatoplasty (LAUP) has been used as treatment for obstructive sleep apnea (OSA) in adults.

Objectives

To perform a systematic review and meta-analysis for LAUP alone as treatment for OSA.

Data sources

Five databases (including PubMed/MEDLINE) were searched through October 30, 2016.

Study eligibility criteria, participants and interventions

Peer-reviewed studies, with any design/language for OSA patients who have undergone LAUP.

Study appraisal/synthesis methods

A study quality assessment tool was used. A meta-analysis was performed.

Results

Twenty-three adult studies (717 patients) reported outcomes (age: 50±9 years, body mass index: 29±4 kg/m2). The pre and post-LAUP means (M) ± standard deviations (SD) for apnea-hypopnea index (AHI) were 28±13 and 19±12 events/hr (32% reduction). Random effects modeling for 519 patients demonstrated an AHI mean difference (MD) of -6.56 [95% CI -10.14, -2.97] events/hr. Individual patient data analyses demonstrate a 23% success rate (≥50% reduction in AHI and >20 events/hour) and an 8% cure rate. Additionally, 44% of patients had worsening of their AHI after LAUP. Lowest oxygen saturation improved from a M±SD of 80±8% to 82±7%.

Limitations

Most studies were case series studies and two were randomized-controlled trials.

Conclusion

In this meta-analysis, laser-assisted uvulopalatoplasty reduced apnea-hypopnea index by 32% among all patients; while the lowest oxygen saturation only changed minimally. Individual data demonstrated a success rate of 23%, cure rate of 8%, and worsening of the AHI among 44% of patients. We recommend that LAUP be performed with caution or not performed at all given the unfavorable results of currently published studies.

Author notes

*Macario Camacho, MD Otolaryngology-Head and Neck Surgery 1 Jarrett White Road Tripler Army Medical Center, HI 96859 Email: drcamachoent@yahoo.com