Researchers at the University of Adelaide have suggested that surgery for obstructive sleep apnoea has no clear benefit and therefore should not be offered as a first treatment.
Guidelines suggest continuous positive airway pressure (CPAP) with weight and alcohol management, as the first line treatment. However, upper airway surgery is becoming increasingly popular, reports BMJ.
The study, conducted by Dr Adam Elshaug and colleagues, analysed existing evidence for upper airway surgery and found that the results of surgery were inconsistent.
Researchers re-examined seven randomised trials and found that the surgery had a general lack of impact on symptoms and, even where improvements in quality of life have been shown immediately after surgery, these were rarely sustained beyond 12-24 months.
In another review of 48 studies, it was found that up to 62 percent of patients who had surgery reported persistent adverse effects, such as dry throat, difficulty in swallowing, voice changes, and disturbances of smell and taste. Up to 22 percent regretted having surgery.
Dr Elshaug and colleagues said that weight loss and other lifestyle modification is suggested as an adjunctive treatment to CPAP, but can be difficult to achieve.
They said that CPAP treatment depends on acceptance and adherence by patients and its benefits in mild to moderate sleep apnoea seem inconclusive, and that makes surgical treatment seem more attractive.
But, given the lack of clear benefit from surgery and the potential for harm indicated by currently available evidence, guidelines suggest CPAP as first line treatment for obstructive sleep apnoea generally.
Researchers have also said that surgery for obstructive sleep apnoea should be done within controlled clinical trials. Patients should be informed about the trial, as well as of the inconsistent results of surgery, the associated pain, the potential side effects, and the potential for relapse.
The study is published in BMJ.