Practice Parameters for the Treatment of Obstructive Sleep Apnea in Adults: The Efficacy of Surgical Modifications of the Upper Airway

Abstract

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America regarding the role of surgical procedures in the treatment of obstructive sleep apnea in adults. Surgical procedures that are considered include: uvulopalatopharyngoplasty, laser midline glossectomy and lingualplasty, inferior sagittal mandibular osteotomy and genioglossal advancement with hyoid myotomy and suspension, maxillomandibular osteotomy and advancement, and tracheotomy. Whenever possible, conclusions are based on evidence from review of the literature. In instances where scientific data are absent, insufficient or inconclusive, recommendations are based on consensus of opinion. The Standards of Practice Committee of the American Sleep Disorders Association appointed a task force to review the topic, the surgical treatment of obstructive sleep apnea. Based on the review and consultation with specialists, the subsequent recommendations were developed by the Standards of Practice Committee and approved by the Board of Directors of the American Sleep Disorders Association. Recommendations are as follows: The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy. The desired treatment outcomes include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of the apnea-hypopnea index and oxyhemoglobin saturation levels. Because of the complexity of airway narrowing or collapse during sleep, any one surgical procedure may not eradicate a patient's sleep apnea. A stepwise approach to surgical management is acceptable if the patient is advised at the onset of treatment about the likelihood of the success of each procedure and that multiple operations may be necessary. After the surgical site has healed, a follow-up evaluation, including an objective measure of respiration and quality of sleep, must be performed to ensure that the abnormalities noted in the original study are corrected.