Surgical Management Of Obstructive Sleep Apnea Research Articles

International palate surgery questionnaire.

This international study aimed at determining current routine palate surgeries and surgical methods adopted by otolaryngologists who practice surgical management ofobstructive sleep apnea (OSA). An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current routines in palatal procedures. The surgeons were asked 33 multiple-choice questions. A total of 141 sleep surgeons answered the questionnaire, of whom 27% were from Africa, 30% from Asia, 24% from Centre-South America, and 19% from Europe. According to otolaryngology surgical specialties, 51% were sleep surgeons, 31% general ENTs, 8% Rhinologists, 7% Head & Neck surgeons, 2% otologists, and 1% maxillofacial surgeons. Of the 141 respondents, 51% answered they were sleep specialists, whereas 49% were non-sleep specialists. According to specific medical degree, 38% were specialists, 33% were consultants, 25% were professors, and 4% were residents or trainees. This study gives an overview of the current surgical practice in OSA management in otolaryngology in different countries.

Current Concepts in the Surgical Management of Pediatric OSA

Given that adenotonsillar hypertrophy is a common cause of upper airway obstruction in children with obstructive sleep apnea (OSA), adenotonsillectomy (T&A) has long been the first-line management approach. Despite the positive outcomes associated with this procedure, persistent disease occurs postoperatively in 34 % of children. A number of studies have therefore used drug-induced sleep endoscopy and other methods to identify sites of upper airway obstruction that may be amenable to surgical correction. Research is increasingly focused on the effectiveness of surgical procedures other than T&A, such as suturing of the tonsillar pillars, expansion pharyngoplasty, lingual tonsillectomy, supraglottoplasty, rapid maxillary expansion, and tongue suspension. This article presents an overview of these topics, focusing on current concepts in the surgical management of OSA.

Temporal trends in sleep apnea surgery: 1993–2010

Growing evidence supports the use of multilevel surgery to effectively address obstructive sleep apnea (OSA). We sought to characterize changes in the patterns of surgical sleep care over time. Repeated cross-sectional study. Discharge data from the US Nationwide Inpatient Sample for 232,470 patients who underwent nasal, palatal, or hypopharyngeal procedures for sleep disordered breathing or OSA from 1993 to 2010 were analyzed using cross-tabulations and multivariate regression modeling. Inpatient sleep surgical procedures increased from 97,363 performed in 1993-2000 to 135,107 in 2001-2010. Sleep surgery in 2001-2010 was associated with increased hypopharyngeal surgery (relative risk ratio [RRR] = 3.6, 95% confidence interval [CI] = 2.6-4.9, P < .001), tongue radiofrequency/midline glossectomy (RRR = 5.1, 95% CI = 3.4-7.5, P < .001), hyoid suspension (RRR = 6.8, 95% CI = 3.8-12.5, P < .001), nasal surgery (RRR = 1.3, 95% CI = 1.1-1.5, P = 0.002), and multilevel surgery (RRR = 5.6, 95% CI = 3.8-9.4, P < .001) and decreased tracheostomy (RRR = 0.58, 95% CI = 0.49-0.68, P < .001) compared to 1993-2000. Patients undergoing sleep surgery in 2001-2010 were more likely to have an OSA diagnosis (RRR = 1.9, 95% CI = 1.4-2.5, P < .001), obesity (RRR = 1.5, 95% CI = 1.4-1.7, P < .001), and advanced comorbidity (RRR = 2.4, 95% CI = 2.0-2.8, P < .001). In 2001-2010, surgeons (>23 cases/yr) in the top-volume quintile were more likely to perform hypopharyngeal procedures (RRR = 2.4, 95% CI = 1.7-3.4, P < .001,) and to be associated with teaching hospitals (RRR = 1.5, 95% CI = 1.0-2.2, P = 0.034) and less likely to perform tracheostomy (RRR = 0.27, 95% CI = 0.18-0.40, P < .001). However, they represented only 17% of surgeons performing sleep surgery in contrast to surgeons in the bottom-volume quintile, who performed 35% of cases. These data reflect changing trends in the surgical management of OSA, with meaningful differences in the type of surgical care provided by high-volume surgeons and a significant increase in surgical sleep procedures, particularly nasal and hypopharyngeal surgery.

The role of the Genial Bone Advancement Trephine system in conjunction with uvulopalatopharyngoplasty in the multilevel management of obstructive sleep apnea

Objectives The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures that address both retropalatal and retrolingual airway obstruction. The Genial Bone Advancement Trephine (GBAT) system is a new, 1-step system that allows for isolation and advancement of the genioglossus muscle via a guided trephine system. The purpose of this project was to describe our experience using the GBAT system to perform genioglossus advancement (GGA) in conjunction with uvulopalatopharyngoplasty (UPPP) in the surgical management of OSA. Study design Retrospective analysis of 35 consecutive patients undergoing GGA using the GBAT system in conjunction with UPPP for the management of OSA during a 3-year period (1999 to 2002). Results Twenty-four patients had complete preoperative and postoperative polysomnographic data. A 70% reduction in the Respiratory Disturbance Index (RDI) and Apnea Index (AI) in the preoperative versus postoperative PSG (RDI, 52.9 ± 17.1 versus 15.9 ± 7.5; AI, 20.1 ± 6.7 versus 6.1 ± 4.5; P ≤ 0.0001). The lowest oxygen desaturation increased from 80% to 88% ( P = 0.0002), and the posterior airway increased from 7.9 to 12.6 mm ( P < 0.0001). With a surgical cure defined as a greater than 50% reduction in the RDI and a final postoperative RDI of less than 20 events per hour, the true surgical cure rate was 67% (16 of 24 patients). Conclusions The GBAT system performed in conjunction with UPPP can produce significant reductions in RDI and AI while improving the oxygen desaturation and enlarging the posterior airway space. The effective cure rates using the GBAT system are in agreement with previous reports in the literature using various GGA techniques. The GBAT may have some advantages in terms of simplicity and safety.