A systematic review of tongue base suspension techniques as an isolated procedure or combined with uvulopalatopharyngoplasty in obstructive sleep apnea.

Abstract

We aimed to evaluate existing research into the effectiveness and safety of two tongue base suspension (TBS) techniques (Repose(®) system and modified TBS) with or without uvulopalatopharyngoplasty (UPPP) in obstructive sleep apnea. The literature review was performed using PubMed database. Searched terms used included the keywords "sleep apnea", "surgery", "tongue", "tongue base", "suspension", "Repose", "uvulopalatopharyngoplasty", and "hypopharynx". Levels of evidences and grades of recommendations were determined according to the hierarchy proposed by Oxford Centre for Evidence-based Medicine. Seven studies including 113 patients met the eligibility criteria for TBS as a stand-alone procedure. Four of seven studies including 62 patients used the Repose(®), and three studies including 51 patients used the modified TBS. The success rates were higher in the studies that used modified technique (74.5%) than those that used the Repose(®) (25.8%), (p<0.001). Ten studies including 300 patients met the eligibility criteria for TBS combined with UPPP. Seven of ten studies including 176 patients used the Repose(®), and three studies including 124 patients used the modified TBS. The success rates in this group were similar between the modified TBS (73.4%) and Repose(®) (67.6%), (p=0.341). When aggregate data of 413 patients were compared, the modified TBS was found to be associated with significantly higher success rates (73.7 vs. 56.7%, p<0.001). The evidence supports primarily grade C recommendations for the benefits of both techniques with or without UPPP; although there is a trend toward improved outcome with modified technique.