Surgical Algorithm for Obstructive Sleep Apnea: An Update

Abstract

<jats:p>Sleep surgery is part of a continuum of care for OSA that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as PAP or oral appliance therapy (OAT). The updated surgical algorithm in this review adds precision in 3 areas: 1) patient selection, 2) identification of previously unaddressed anatomic phenotypes with associated treatment modality, and 3) improved techniques of previously established procedures. While the original Riley and Powell Phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments. </jats:p>

Effect of Modified Uvulopalatopharyngoplasty without Tonsillectomy on Obstructive Sleep Apnea: Polysomnographic Outcome and Correlation with Drug-Induced Sleep Endoscopy

“… 21 In addition, CCC was considered to be a contraindication for the advanced technique of upper airway stimulation. 27 In our study, five patients undergoing UPsT presented CCC in the preoperative sleep endoscopy. All five patients with CCC benefited from the surgery, with a reduction observed in the AHI value, an increase of minimum SaO 2 and an improvement in daytime sleepiness (data not shown).…”

“… 29 Multilevel upper airway surgery, such as UPPP combined with tongue base reduction, was considered a superior therapy to UPPP alone for the treatment of OSA with complete tongue base collapse. 27 The patients with complete tongue base collapse were initially excluded from the present study. Therefore, the superiority of UPsT to other procedures with respect to surgical outcomes was attributable to the exclusion of patients with OSA with complete tongue base collapse.…”

Tonsillectomy in Adults over 40 Years of Age Does Not Increase the Risk of Pneumonia: A Three-Year Longitudinal Follow-Up Study

“…To resolve this issue, we tried to improve the reliability of pneumonia diagnosis by including only subjects who underwent chest X-ray or chest CT. Second, the etiology of tonsillectomy was not included in this study. Tonsillectomy may be performed not only due to chronic and/or recurrent tonsillitis [ 1 ], but also due to chronic tonsillar hypertrophy [ 5 ], halitosis [ 35 ], or OSA [ 36 ]. Because chronic and/or recurrent tonsillitis is of infectious etiology while the other cases are not, there is a possibility that the underlying etiology of tonsillectomy might have affected the incidence of pneumonia.…”

Anatomy and Pathophysiology of Upper Airway Obstructive Sleep Apnoea: Review of the Current Literature

“…The nasal region, especially the internal nasal valve that comprised of septum, upper lateral cartilage, inferior turbinates, and nasal floor are the most important sites. Given that these entities comprise the narrowest portions of the nasal airway, aggravation of nasal obstruction is often found in OSA patients [20]. The nasal region in OSA can be explained by increased nasal airway resistance and the switch from nasal to mouth breathing due to nasal obstruction and impaired nasal ventilatory reflex.…”