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Surgery for Obstructive Sleep Apnea

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Primary Care Sleep Medicine

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Abstract

While positive airway pressure therapy remains the mainstay of treatment for obstructive sleep apnea, tolerance and compliance remain a challenge. As a result, many patients pursue surgical options. Surgical therapy may be employed as an ancillary function to augment or assist other therapies, may be applied as a primarily curative measure, or serve as salvage therapy with an attempt to cure after failure of an alternate therapy. Surgical treatment of obstructive sleep apnea has shown substantial advancements in recent years owing in part to recognition of different sites of collapse of the upper airway as well as to understanding of different mechanisms by which obstruction may occur at each subsite. As such, anatomic based staging is crucial to successful treatment. Multiple surgical options exist at each site of the upper airway and careful patient evaluation can identify which option has the greatest potential to address the obstruction. Despite these advances and improved outcomes, failures of sleep surgery still occur and as a result newer techniques are still being researched and developed.

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Abbreviations

AHI:

Apnea hypopnea index

BMI:

Body mass index

CAPSO:

Cautery-assisted palatal stiffening operation

CPAP:

Continuous positive airway pressure

CT:

Catscan

FDA:

Food and Drug Administration

FTP:

Friedman tongue position

MMA:

Maxillomandibular advancement

MPH:

Mandibular plane-to-hyoid distance

MRI:

Magnetic resonance imaging

OSA:

Obstructive sleep apnea

PAP:

Positive airway pressure

PAS:

Posterior airway space

PSG:

Polysomnogram

TORS:

Transoral robotic surgery

UPPP:

Uvulopalatopharyngoplasty

VPI:

Velopharyngeal insufficiency

ZPP:

Z-palatoplasty

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Author information

Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Katherine McKee-Cole M.D. & Maurits S. Boon M.D.

Authors
  1. Katherine McKee-Cole M.D.
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  2. Maurits S. Boon M.D.
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Corresponding author

Correspondence to Katherine McKee-Cole M.D. .

Editor information

Editors and Affiliations

  1. Sleep Disorders Center, Pueblo, Colorado, USA

    James F. Pagel

  2. Department of Population Health, New York University School of Medicine / Center for Healthful Behavior Change, New York, New York, USA

    S. R. Pandi-Perumal

Review Questions

Review Questions

  1. 1.

    T/F—Current staging for surgical candidates for sleep apnea is based on PSG findings

    (False—current staging is based on anatomic parameters)

  2. 2.

    Name 3 anatomic regions addressed in sleep apnea surgery

    (Nasal, palatal, hypopharyngeal, facial skeletal (maxilla, mandible))

  3. 3.

    T/F—Sleep endoscopy is completed during PSG testing

    (False—sleep endoscopy is a procedure completed in the operating room during which an otolaryngologist examines the airway during sedation with propofol to assess sites of obstruction during sleep-like conditions)

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McKee-Cole, K., Boon, M.S. (2014). Surgery for Obstructive Sleep Apnea. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_15

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  • DOI: https://doi.org/10.1007/978-1-4939-1185-1_15

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1184-4

  • Online ISBN: 978-1-4939-1185-1

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