Baba Ridhwan Y, Mohan Arjun, Metta V V S Ramesh, Mador M Jeffery
Department of Internal Medicine, University at Buffalo, Buffalo, NY, USA.
Sleep Breath. 2015 Sep;19(3):891-910. doi: 10.1007/s11325-015-1125-y. Epub 2015 Feb 3.
This study seeks to determine the efficacy of temperature controlled radiofrequency tissue ablation (TCRFTA) to alleviate symptoms of obstructive sleep apnea (OSA) and reduce polysomnographic measures of OSA in the first year post-treatment.
Systematic review and meta-analysis. Two independent searches of MEDLINE, EMBASE bibliographic databases, and Evidence Based Medicine Reviews to identify publications relevant to OSA and TCRFTA. Effectiveness of TCRFTA was measured separately for application of TCRFTA at the base of tongue and soft palate, and for multilevel intervention using the respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), Epworth sleepiness scale (ESS), and bed partner's rating of snoring using a visual analogue scale (VAS snoring). The most recent search was conducted in April 2013. Statistical analysis was performed using Review Manager Version 5.2 using a relative measure of effect, i.e., ratio of means (RoM).
Our initial search resulted in 29 eligible studies, and subsequently, 20 studies were included in the meta-analysis. Substantial and consistent improvement in PSG and subjective outcomes were observed post-TCRFTA in the base of tongue (BOT) and multilevel surgery groups only. Application of TCRFTA at the BOT was associated with a significant reduction in RDI (RoM 0.60, CI 0.47-0.76), ESS (RoM 0.59, CI 0.51-0.67), and VAS snoring (RoM 0.48, CI 0.37-0.62) and increase in lowest oxygen saturation (RoM 1.05, CI 1.01-1.10). Similarly, a significant reduction in RDI (RoM 0.61, CI 0.47-0.80) and ESS (RoM 0.79, CI -0.71 to 0.88) was observed after multilevel TCRFTA, but substantial heterogeneity between these studies was observed.
TCRFTA is clinically effective in reducing RDI levels and symptoms of sleepiness in patients with OSA syndrome when directed at the base of tongue or as a multilevel procedure.
本研究旨在确定温控射频组织消融术（TCRFTA）在治疗后第一年缓解阻塞性睡眠呼吸暂停（OSA）症状及降低OSA多导睡眠图测量指标的疗效。
系统评价和荟萃分析。对MEDLINE、EMBASE文献数据库及循证医学评价进行两项独立检索，以识别与OSA和TCRFTA相关的出版物。分别针对在舌根和软腭处应用TCRFTA以及采用多级干预，使用呼吸紊乱指数（RDI）、最低血氧饱和度（LSAT）、爱泼华嗜睡量表（ESS）以及通过视觉模拟量表（VAS打鼾）对床伴的打鼾评分来衡量TCRFTA的有效性。最近一次检索于2013年4月进行。使用Review Manager 5.2软件，采用效应的相对测量指标，即均值比（RoM）进行统计分析。
我们最初的检索得到29项符合条件的研究，随后，20项研究被纳入荟萃分析。仅在舌根（BOT）和多级手术组中，观察到TCRFTA术后多导睡眠图和主观结果有显著且持续的改善。在BOT处应用TCRFTA与RDI显著降低（RoM 0.60，CI 0.47 - 0.76）、ESS显著降低（RoM 0.59，CI 0.51 - 0.67）以及VAS打鼾显著降低（RoM 0.48，CI 0.37 - 0.62）相关，且最低血氧饱和度增加（RoM 1.05，CI 1.01 - 1.10）。同样，多级TCRFTA术后观察到RDI显著降低（RoM 0.61，CI 0.47 - 0.80）和ESS显著降低（RoM 0.79，CI - 0.71至0.88），但这些研究之间存在显著异质性。
当针对舌根或作为多级手术时，TCRFTA在降低OSA综合征患者的RDI水平和嗜睡症状方面具有临床有效性。
