OSA Surgery: Reviewing the Reviews and Their Implications

Abstract

Program Description: The American Academy of Sleep Medicine and Agency for Healthcare Research and Quality have recently published controversial systematic reviews of the obstructive sleep apnea (OSA) surgery literature. These are now being used by third-party payors to reconsider coverage policies, including those for soft palate procedures such as uvulopalatopharyngoplasty. The purpose of this miniseminar is to present these reviews and the debates they raise, examine the available higher level studies, and present a framework for evaluating OSA surgery outcomes. AASM and AHRQ reviews. Systematic reviews can synthesize are powerful but challenging tools that can help guide clinical decisions. Any review has general as well as specific strengths and weaknesses, whether related to methods that require oversimplification of each study’s findings, selection of outcome measures to compare results across studies, or the scope of the review that leaves certain studies excluded. This segment will examine the reviews’ methods and findings, highlighting their importance as well as gaps, particularly those regarding multilevel OSA surgery and the evaluation of sleep study outcomes alone. As for most surgical fields, the bulk of the OSA surgery literature consists of case series studies, with all of their inherent limitations. However, there are a number of higher level OSA surgery studies, including randomized trials and cohort studies. The program will review these higher level studies and provide grades for the available evidence concerning OSA surgical interventions. As for every surgical intervention, outcomes after OSA surgery vary widely, not only among various procedures but also for individual patients. There is a tendency to criticize or discard procedures that do not achieve ideal outcomes universally. The alternative is to pursue a nuanced evaluation of whether those patients who appear to respond to surgery achieve meaningful clinical improvements and also to match procedures and patients in order to increase the proportion of treated patients who do respond to surgery. This portion of the miniseminar will review evidence showing that there is a subgroup of patients who obtain meaningful clinical improvements after surgery, strategies to match procedures and patients, and a framework for presenting and reading results of sleep surgery trials that is based on this variation in outcomes. Educational Objectives: 1) Learn the findings of recent OSA surgery reviews, along with their strengths and weaknesses. 2) Understand the findings of higher-level studies in the field. 3) Appreciate the variation in outcomes across procedures and patients, along with the implications.