Comparing Hyoid Suspension Approaches in Multilevel Sleep Surgery: A Systematic Review and Meta-Analysis

Hyoid suspension is a method used to address hypopharyngeal obstruction in multilevel surgery for obstructive sleep apnea (OSA). The procedure involves suspending the hyoid bone to either the mandible or thyroid cartilage, determined by surgeon preference. This meta-analysis aims to compare the effectiveness of these two approaches in multi-level sleep surgery.

PubMed, Embase, Scopus, and The Cochrane Library.

All studies underwent a 2-stage blinded screening, extraction, and evaluation process. Primary outcomes of the study included pre- and postoperative apnea hypopnea index (AHI), Sher surgical success rate (≥50% reduction in AHI and postoperative AHI < 20), and changes to Epworth Sleepiness Scale (ESS) Score.

Database searches yielded 1502 studies with 74 full-text articles screened, and 21 studies ultimately included. In patients who underwent hyothyroidpexy and palatal surgery (n = 582), the average AHI was reduced 20.98 (confidence interval 16.87, 25.08), ESS score improved by 5.99 [4.35, 7.63], and 57.5% met Sher criteria for surgical success. Patients who received hyomandibular suspension (n = 141) achieved an average AHI reduction of 29.21 [20.87, 37.55], improvement in ESS by 4.4 [1.33, 7.51], and Sher success rate of 73.8%. Although improvement in AHI and ESS scores were not statistically significant between groups, the proportion of patients meeting Sher Criteria success was greater for hyomandibular suspension (P = .006) CONCLUSION: The results of this study show that both methods of hyoid suspension are effective in treating OSA when used as a component of multilevel sleep surgery but suggests that hyomandibular suspension may provide greater improvement than hyothyroidpexy.