Isolated Tonsillectomy Valid Treatment for OSA in Some Adults

Do sleepiness and sleep study variables including the apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA)?

Bottom Line: Isolated tonsillectomy can be successful as treatment for adult OSA, especially among patients with large tonsils and mild to moderate OSA (AHI < 30 per hour).

Background: Tonsillectomy is not mentioned as an isolated surgery option for treating adult OSA in the American Academy of Sleep Medicine practice guidelines, but a consensus statement for the academy’s Adult Obstructive Sleep Apnea Task Force has stated that it can be considered for patients with mild OSA who have severe obstructing anatomy that is surgically correctible (e.g., tonsillar hypertrophy obstructing the pharyngeal airway).

Study design: Systematic review and meta-analysis of 17 case reports, case series, and case control studies (216 patients) from nine databases searched through November 24, 2015.

Setting: Databases: Book Citation Index–Science, Cumulative Index to Nursing and Allied Health, Conference Proceedings Citation Index–Science, Embase, Google Scholar, PubMed/MEDLINE, Scopus, The Cochrane Library, and Web of Science.

Synopsis: The overall meta-analysis of the 17 studies demonstrated that isolated tonsillectomy reduced AHI from a mean ± standard deviation of 40.5 ± 28.9 to 14.1 ± 17.1 events per hour, a 65.2% decrease. The random effects analysis demonstrated an AHI mean difference (MD) of -30.2 events per hour. The lowest oxygen saturation improved from 77.7 ± 11.9% to 85.5 ± 8.2%. The Epworth sleepiness scale decreased from 11.6 ± 3.7 to 6.1 ± 3.9 with an MD of 25.49. Treatment success varied with patients who were morbidly obese or had severe OSA. Posttonsillectomy success (decrease by ≥ 50% and a total AHI < 20 events per hour) was observed in 46 out of 54 patients. Posttonsillectomy AHI decreased by ≥ 50% and had a total < 15 events per hour or < 10 events per hour in 81.4% and 72.2%, respectively. Posttonsillectomy cure was observed in 31 out of 54 patients. Age, BMI < 30 kg/m2, preoperative AHI, and LSAT were all predictive of surgical cure. All 25 patients with preoperative AHI < 30 events per hour met the S20, S15, and S10 definitions for surgical success. Limitations included a lack of cohort studies or randomized/randomized-controlled studies, and that less than 25% of patients had individual data available for subanalysis.

Citation: Camacho M, Li D, Kawai M, et al. Tonsillectomy for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2016;126:2176-2186.