The surgical treatment of sleep-related upper airway obstruction

Abstract

Background: Obstructive sleep apnea (OSA) is a very common disorder among adults: the prevalence of mild OSA is 20%, and that of moderate or severe OSA is 6% to 7%. Simple snoring is even more common. Conservative treatments such as nocturnal ventilation therapy and oral appliances are successful as long as the patient actually uses them, but they do not eliminate the underlying obstruction of the upper airway.

Method: The relevant literature up to 2008 on the surgical treatment of OSA was selectively reviewed.

Results: Five types of surgical treatment for OSA are available, each for its own indications: optimization of the nasal airway to support nasal ventilation therapy, (adeno-)tonsillectomy as first-line treatment for OSA in children, minimally invasive surgery for simple snoring and mild OSA, invasive surgery as first- and second-line treatment for mild OSA, and invasive multilevel surgery as second-line treatment of moderate to severe OSA that remains refractory to ventilation therapy.

Conclusion: Surgical treatment for OSA is appropriate for specific indications as a complement to the established conservative treatment methods.

Figure

Objective surgical success in sleep surgical interventions for the treatment of obstructive sleep apnea depending on the apnea-hypopnea index (AHI) and body mass index (BMI). Success rate as defined by Sher (9)—that is, reduction of AHI by at least 50% and reduction of AHI to below 20), N = 263 patients; with permission from (22)