Update on surgical treatments for sleep apnea.

Abstract

Many patients with obstructive sleep apnoea (OSA), as well as the medical community, are seeking alternative therapies to continuous positive airway pressure (CPAP). Where there are problems with CPAP adherence, surgical procedures are an option without the need for adequate compliance. A wide variety of surgical procedures is available, all of which address the differing anatomy and types of patients requiring specific evaluation of the available data. The author performed a literature search up to October 2008, the studies being evaluated according to EBM criteria. The data for some of the methods was limited. Minimally invasive surgery is helpful due to its positive efficacy vs morbidity ratio. While UPPP is still the standard procedure in mild to moderate OSA, its success is difficult to predict and often falls off with the passage of years. Additional upper airway investigations have not yet succeeded in overcoming this disadvantage. Combined surgery of the multi-level is reserved for secondary treatment after CPAP failure. Only tonsillectomy and maxillomandibular advancement are successful enough to be considered a first-line treatment in certain patients.