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Surgery for Obstructive Sleep Apnea

Chapter

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.

Keywords

Obstructive Sleep Apnea Bariatric Surgery Positive Airway Pressure Tongue Base Oral Appliance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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

References

  1. 1.
    Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5(2):173–8.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Kezirian EJ. Nonresponders to pharyngeal surgery for obstructive sleep apnea: insights from drug-induced sleep endoscopy. Laryngoscope. 2011;121(6):1320–6. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3100447&tool=pmcentrez&rendertype=abstract. Accessed 1 Jun 2013.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Al-Shawwa B, Badi AN, Goldberg AN, Woodson BT. Defining common outcome metrics used in obstructive sleep apnea. Sleep Med Rev. 2008;12(6):449–61. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19010289. Accessed 29 May 2013.PubMedCrossRefGoogle Scholar
  4. 4.
    Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope. 2004;114(3):454–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15091218.PubMedCrossRefGoogle Scholar
  5. 5.
    Hsueh-Yu L, Wang P, Lee L, Chen N, Fang T. Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system. Sleep. 2006;29(12):1537–41.Google Scholar
  6. 6.
    George JR, Chung S, Nielsen I, Goldberg AN, Miller A, Kezirian EJ. Comparison of drug-induced sleep endoscopy and lateral cephalometry in obstructive sleep apnea. Laryngoscope. 2012;122(11):2600–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23086863. Accessed 1 Jun 2013.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Friedman M, Schalch P. Surgery of the palate and oropharynx. Otolaryngol Clin North Am. 2007;40(4):829–43. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17606025. Accessed 1 Jun 2013.PubMedCrossRefGoogle Scholar
  8. 8.
    Borek RC, Thaler ER, Kim C, Jackson N, Mandel JE, Schwab RJ. Quantitative airway analysis during drug-induced sleep endoscopy for evaluation of sleep apnea. Laryngoscope. 2012;122(11):2592–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22965547. Accessed 1 Jun 2013.PubMedCrossRefGoogle Scholar
  9. 9.
    Rabelo F, Braga A, Küpper D, Jose A, Lopes F, Mattos P, et al. Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg. 2010;142(2):218–24. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20115978. Accessed 29 May 2013.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson JT, Braun BW. Preoperative, intraoperative and postoperative management of patients with obstructive sleep apnea. Otolaryngol Clin North Am. 1998;31(6):1025–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Victores AJ, Takashima M. Effects of nasal surgery on the upper airway: a drug-induced sleep endoscopy study. Laryngoscope. 2012;122(11):2606–10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22886986. Accessed 29 May 2013.PubMedCrossRefGoogle Scholar
  12. 12.
    Thatcher GW, Maisel RH. The long-term evaluation of tracheostomy in the management of severe obstructive sleep apnea. Laryngoscope. 2003;113(2):201–4. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12567068.PubMedCrossRefGoogle Scholar
  13. 13.
    Woodson TB. Non-pressure therapies for obstructive sleep apnea: surgery and oral appliances. Respir Care. 2010;55(10):1314–21. discussion 1321; Available at: http://www.ncbi.nlm.nih.gov/pubmed/20875158.PubMedGoogle Scholar
  14. 14.
    Friedman M, Tanyeri H, Lim J. Effect of improved nasal breathing on obstructive sleep apnea. Head Neck Surg. 2000;122(1):71–4. Available at: http://www.sciencedirect.com/science/article/pii/S0194599800701471. Accessed 1 Jun 2013.CrossRefGoogle Scholar
  15. 15.
    Kohler M, Bloch KE, Stradling JR. The role of the nose in the pathogenesis of obstructive sleep apnea. Curr Opin Otolaryngol Head Neck Surg. 2009;17(1):33–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19225303. Accessed 1 Jun 2013.PubMedCrossRefGoogle Scholar
  16. 16.
    Friedman M, Wilson M, Lin HC, Chang HW. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140(6):800–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Pang KP, Terris DJ. Modified cautery-assisted palatal stiffening operation; New method for treating snoring and mild obstructive sleep apnea. Otolaryngol Head Neck Surg. 2007;136:823–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Kezirian EJ, Maselli J, Vittinghoff E, Goldberg AN, Auerbach AD. Obstructive sleep apnea surgery practice patterns in the United States: 2000 to 2006. Otolaryngol Head Neck Surg. 2010;143(3):441–7. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2924589&tool=pmcentrez&rendertype=abstract. Accessed 1 Jun 2013.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Pang KP, Tan R, Puraviappan P, Terris DJ. Anterior palatoplasty for the treatment of OSA: three-year results. Otolaryngol Head Neck Surg. 2009;141(2):253–6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19643261. Accessed 29 May 2013.PubMedCrossRefGoogle Scholar
  20. 20.
    Pang KP, Woodson TB. Expansion sphincter pharyngoplasty: a new technique for treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2007;137:110–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Woodson TB. Transpalatal advancement pharyngoplasty. Oper Tech Otolaryngol. 2007;18:11–6.CrossRefGoogle Scholar
  22. 22.
    Pang KP, Woodson TB. Expansion sphincter pharyngoplasty in the treatment of obstructive sleep apnea. Oper Tech Otolaryngol Head Neck Surg. 2006;17(4):223–5. Available at: http://linkinghub.elsevier.com/retrieve/pii/S1043181006001114. Accessed 13 Jun 2013.CrossRefGoogle Scholar
  23. 23.
    Woodson TB. Structural effectiveness of pharyngeal sleep apnea surgery. Sleep Med Rev. 2008;12(6):463–79. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19010290. Accessed 29 May 2013.CrossRefGoogle Scholar
  24. 24.
    Bowden MT, Kezirian EJ, Utley D, Goode RL. Outcomes of hyoid suspension for the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2005;131(5):440–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15897424.PubMedCrossRefGoogle Scholar
  25. 25.
    Friedman M, Hamilton C, Samuelson CG, Kelly K, Taylor D, Pearson-Chauhan K, et al. Transoral robotic glossectomy for the treatment of obstructive sleep apnea-hypopnea syndrome. Otolaryngol Head Neck Surg. 2012;146(5):854–62. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22247514. Accessed 12 Jun 2013.PubMedCrossRefGoogle Scholar
  26. 26.
    Caples S, Rowley J, Prinsell J. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review. Sleep. 2010;33(10):1396–407. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941427/. Accessed 12 Jun 2013.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Goh YH, Lim KA. Modified maxillomandibular advancement for the treatment of obstructive sleep apnea: A preliminary report. Laryngoscope 2003; 113:1577–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Solh AA, Jaafar W. A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients. Crit Care. 2007;11(1):R3.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Sarkosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23.CrossRefGoogle Scholar
  30. 30.
    Friedman M, Soans R, Joseph N, Kakodkar S, Friedman J. The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome. Laryngoscope. 2009;119(1):193–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Eastwood P, Barnes M, Walsh J. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep. 2011;34(11):1479–86. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3198202/. Accessed 12 Jun 2013.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Goh YH, Mark I, Fee WE. Quality of life 17 to 20 years after uvulopalatopharyngoplasty. Laryngoscope. 2007;117:503–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Kezirian EJ, Weaver EM, Criswell MA, de Vries N, Woodson BT, Piccirillo JF. Reporting results of obstructive sleep apnea syndrome surgery trials. Otolaryngol Head Neck Surg. 2011;144(4):496–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21493223. Accessed 29 May 2013.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Otolaryngology – Head and Neck SurgeryThomas Jefferson University HospitalPhiladelphiaUSA

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