Pre-Intervention OSA measure 12 previously diagnosed with OSA (details not provided) AHI mean 22.3 Mean Sp02: 93.7%

Transcription

1 Coeugniet et al Mitsukawa et al Filiaci et al Nout et al Apert 5 Crouzon 2 Pfeiffer 11-4 Crouzon 3 Pfeiffer 4 2 Crouzon 1 Apert 9-5 Crouzon All patients with known OSA undergoing distraction without maxillary osteotomy Series of those patients undergoing distraction early on the basis of having OSA Selected group from recent experience of 12 cases of advancement Cases undergoing midface advancement with PSG data 2.7 yrs (0.3-10) 2 yrs median (0.6 3) 5-9 yrs range 12.9yrs ( ) 12 previously diagnosed with OSA (details not provided) AHI 22.3 Mean Sp02: 93.7% AHI 34.3 Sp02 nadir 80.2% ODI for seven patients with reliable data 21.9 Post-operative polysomnogrpahy demonstrated no OSA AHI 2.6 Mean Sp02: 98.5% AHI 3.3 Sp02 nadir 92.7% ODI for seven patients with reliable data 6.1 PSG details not reported. Reasonable numbers Complete of series. Moderate numbers. No long term follow up Incomplete, selected cases. Small numbers. Incomplete data. Selected cases. Xu et al Ettinger et al Syndrome not stated Crouzon 7 Le Fort 3 osteotomy with known OSA. 5 year series of le fort 3, those with data 10.2 yrs 8.7 yrs (5.1-11) AHI 30.0 and 14.4 Mean Sp02 91 and 97 Nadir Sp02 68 and 62 AHI 4.4 and 1.1 Mean Sp02 99 and 98 Nadir Sp02 93 and 84. Very small numbers, selected cases AHI 20.6 ( ) AHI 9.7 ( ) Selected cases Gasparini et al Flores et al Mathijssen et al Crouzon 10 - Syndromes not stated Syndromes not stated Series of all patients undergoing midface distraction who also have sleep data Patients with SDB in a series of those under 12.5 years undergoing Le Fort 3 distraction. Le Fort 3 distraction or monobloc procedure 8.9 yrs (1-16) 5.7 yrs 5.2 yrs 8 severe OSA, 4 moderate, 2 mild OACT score tracheostomy 8 severe OSA 13 tracheostomy 7 severe OSA 14 mild OSA 4 mild, 10 no OSA OACT score tracheostomy 2 moderate OSA 1 mild OSA 5 clinical (not defined) 5 tracheostomy 2 mild OSA 52 normal parameters Multiple outcome s, fully reported Variable outcome s. Subjective outcomes Variable outcome. Incomplete /

2 Bannink et al Nelson et al Fearon Crouzon 6 Pfeiffer Crouzon 6 Apert 6 Pfeiffer 4 Muenke 1 12 syndrome not stated Le Fort 3 distraction or monobloc procedure with sleep data Le Fort 3 distraction with evidence of SDB pre-op Le Fort 3 osteotomy at one centre. (inc revisions) 14.9 yrs ( ) 10.4 yrs ( ) 8 yrs (3-16) 25 normal parameters subjective assessment Variable s at different points, narrative of Narrative patients generally showing., inconsistent 6 tracheostomy. 2 central apnoea BIPAP Remaining 10: RDI 33.4 Nadir 82.8% AHI 12.1 RDI 24 Nadir 81% 1 tracheostomy 2 ongoing central apnoea. Remaining 15: RDI 12.6 Nadir 89.3% AHI 3.0 RDI 11 Nadir 89% Table 1: Outcomes from craniofacial surgery. PSG polysomnogrpahy. AHI apnoea hyponoea index. RDI respiratory disturbance index. ODI oxygen desaturation index. s Variable outcome s, but reasonable size group Selected patient group

3 Zandieh et 5.6 yrs al Al-Saleh et al Amonoo- Kuofi et al Willington et al Moore Apert, 6 Pfeiffer, 5 Crouzon. 7-4 Crouzon 3 Apert Crouzon 9 Apert, 3 Pfeiffer 3 SaethreC 1 AntleyB 5 3 Crouzon 2 Apert 6 3 Crouzon 2 Apert all patients seen at one centre. 62% of patients had AT all patients with PSG data who had intervention (other intervention outcomes listed on other tables) all patients undergoing AT with pre and postop sleep studies all patients undergoing AT with pre and postop sleep studies all patients undergoing surgery for airway obstruction 4.3 yrs 4.5 yrs 4.0 yrs Not quoted 83 percent had Mean apnea/hypopnea index was not obstructive sleep apnea significantly different, and obstructive (42% severe, 19% sleep apnea persisted in 11 of 13 moderate, 22% mild) children Mean AHI: 21 Mean AHI: 15 AHI 18.8 ( ) AHI 19.6 ( ) General patient masked by one with grossly higher AHI. Significant latency between operation and post-op sleep study 7 had severe OSA 11 had moderate OSA 7 had mild OSA 10.9 ODI Variable s used. ODI quoted for three patients ( 28.3) Variable reports of desaturation frequency and nadir 15 (60%) demonstrated 3 had severe OSA 6 had moderate OSA 11 had mild OSA 5 had normal parameters 3.9 ODI Variable s used. ODI quoted for 3 patients (different 3 patients from preop ODI figures) ( 4.7) Matched reports on desatruation frequency and nadir. Significant Table 2: Outcomes from adenotonsillectomy. AT adenotonsillectomy. PSG polysomnogrpahy. ODI oxygen desaturation index. AHI apnoea hypopnoea index. No significant benefit Mixed Moderate Long follow up, comprehensive patient group, reasonable numbers Small studies. Latency prior to post-op sleep study Reasonable numbers, comprehensive Small study. Incomplete / variable outcome Small study Partially subjective outcomes

4 Moore. 19 Not quoted Al-Saleh et al Crouzon 2 Pfeiffer all patients undergoing surgery for airway obstruction 1 Apert All patients with PSG data who had intervention (other intervention outcomes listed on other tables) Table 3: Outcomes from palatal surgery. PSG polysomnogrpahy. AHI apnoea hypopnoea index yrs Pre-Intervention OSA Variable reports of desaturation frequency and nadir Matched reports on desatruation frequency and nadir. Significant palatal surgery AHI 9.0 AHI 2.0 palatal release Small study Partially subjective outcomes Single patient in this part of study

5 Ahmed et al yrs Randhawa et al Kouga et al Crouzon 12 Apert 4 Pfeiffer 1 SaethreC Crouzon 9 Apert 3 Pfeiffer 11 - Crouzon 7 Pfeiffer 3 Apert 1 all craniofacial patients at one centre managed with NPA all craniofacial patients at one centre managed with NPA patients undergoing NPA Not quoted 2.76 yrs ( ) 17 severe OSA. 10 moderate OSA. Mean ODI: had concomitant adenoidectomy 10 severe OSA 6 moderate OSA 1 mild OSA All reported to have airway compromise Table 4: Outcomes from nasopharyngeal airway / nasal prong. NPA nasopharyngeal airway. ODI oxygen desaturation index. QoL quality of life. 3 moderate OSA. 24 mild OSA. Mean ODI: moderate OSA. 14 mild OSA. Principle outcome was QoL. 88% kept for >6 months. 65% kept for >12 months 8/11 reported 64% kept for >6 months Consistent outcome. Reasonable numbers. Good follow up Significant overlap with above series. Main outcome was QoL Subjective outcome

6 Al-Saleh et 1.2 yrs al Jarund et al Gonsalez et al Crouzon 9 - Crouzon 4 Pfeiffer Crouzon 3 All patients with PSG data who had intervention (other intervention outcomes listed on other tables) Patients with confirmed OSA, all started on nasal CPAP Patients entered into prospective trial. 3 patients 3.6 yrs years range AHI 16.2 ( ) AHI 8.2 ( ) Slight 2 were unable to commence CPAP. Of remaining 7: ODI: 37.1 (5-120) Mean O2 sats 91.1% (inc active and passive sleep) ODI 2.0 (0-6). 2 of 7 were unable to tolerate Mean O2 95.4% 2 of 8 were unable to tolerate Pfeiffer 2 Table 5: Outcomes with CPAP. PSG polysomnography. CPAP continuous positive airways pressure. AHI apnoea hypopnoea index. ODI oxygen desaturation index. Very small group Continuous series, complete outcome Prospective series, complete outcome