SLEEP APNEA | Surgery for Sleep Apnea

Abstract

Surgical treatment of severe obstructive sleep apnea syndrome (OSAS) is currently generally considered as second line therapy after the reference treatment, nasal continuous positive airway pressure (CPAP). In upper airway (UA) resistance syndrome (UARS) and mild and moderate OSAS subjects, surgery is progressively being replaced by oral appliance therapy. This article discusses the rationale for surgical therapy. The surgical procedures for uvulopalatopharyngoplasty (UPPP), nasal surgery, tongue operations, and maxillofacial surgery are described. Young and lean subjects are probably the best candidates for surgery. The methods that appear at this time to be the most clinically useful to detect UA narrowing or collapse sites are cephalometry and fiberoptic endoscopy. However, satisfactory selection of good surgical candidates remains elusive. UPPP treatment response rate in OSAS varies from 5% to 46% depending on the presence or absence of retrolingual narrowing. Maxillomandibular advancement osteotomy (MMO) is an efficient surgical technique for the treatment of severe sleep apnea, particularly in young motivated and nonobese patients. Acute UA obstructions are the more frequent life-threatening complication occurring in the early postoperative procedure. These complications can be avoided by standardizing anesthetic procedures and perioperative protocols. In children obstructive sleep apnea is an adequate indication for adenotonsillectomy. There is need for regular re-evaluation of surgical results and adjustment of treatment at regular time intervals.