Background: Obstructive Sleep Apnea (OSA) is caused by a partial or complete obstruction of the upper airway. OSA is a very inconvenient and relatively common disorder with daytime and nocturnal symptoms. The intervention and management of OSR is dependent on the patients' case severity. The aim of this study was to evaluate the role and the optimal choice of Tonsillectomy for treatment of OSR.
Methods: a systematic search in the scientific database (Medline, EMBASE, Google Scholer and Ovid) from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled trials, cohort studies and case–control studies were analyzed and included based on the preset inclusion and exclusion criteria. Results: the search has yieldedtwelve studies to be included in the present SR (n = 206 patients, 34.4 ± 10.0 years and body mass index: 29.3 ± 9.6 kg/m2) met criteria. Tonsils sizes were hypertrophied, large, enlarged, extremely enlarged, or grades 2 to 4. Apnea-Hypopnea Index decreased by 65.2% (from 43.7± 21.7 /hour to 13.7 ± 12.7 /hour) (n = 198). The AHI mean difference (MD) was −30.2 per hour (95% confidence interval [CI] −39.3, −21.1) (P value < 0.00001). The AHI SMD was −1.37 (−1.65, −1.09) (large effect). Lowest oxygen saturation improved from 77.7 ± 11.9% to 85.5 ± 8.2% (n = 186). Lowest oxygen saturation MD was 8.5% (95% CI 5.2, 11.8) (P value < 0.00001). The Epworth Sleepiness Scale decreased from 11.6 ± 3.7 to 6.1 ± 3.9 (n = 125). Individual patient outcomes (n = 52) demonstrated an 85.2% success rate (AHI < 20/hour and ≥ 50% reduction) and a 57.4% cure rate.
Conclusion: tonsillectomy is an effective and safe surgical intervention for treatment of OSA in adults, particularly among carefully selected patients with large tonsils and mild to moderate OSA severity.