Elsevier

Sleep Medicine Reviews

Volume 6, Issue 3, June 2002, Pages 195-212
Sleep Medicine Reviews

Regular Article
Upper airway surgery for obstructive sleep apnea

https://doi.org/10.1053/smrv.2002.0242Get rights and content

Abstract

Upper airway surgical treatments for obstructive sleep apnea syndrome (OSAS) attempt to modify dysfunctional pharyngeal anatomy or by-pass the pharynx. Modifications of the pharynx diminish the bulk of soft tissue structures which abut the air column, place them under tension, others alter their spatial inter-relationships. Surgical procedures are designed to modify the retropalatal pharynx, the retrolingual pharynx, or both. There is no single surgical procedure, short of tracheostomy, which consistently results in complete elimination of OSAS. However, appropriate application of current surgical techniques (synchronously or sequentially) may achieve cure in most patients without resort to tracheostomy. Patient selection, versatility in varied surgical approaches, and willingness to utilize more than one procedure when necessary appear to be critical attributes of a successful surgical program. On the other hand, analysis of the efficacy of individual surgical interventions is thwarted by the frequent practice of reporting on the application of multiple procedures in combination with evaluation of the composite effect. Well designed, multi-center studies would help clarify the strengths and weaknesses of different treatment approaches.

References (74)

  • JR Prinsell

    Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients

    Chest

    (1999)
  • LS Aboussouan et al.

    Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea

    Chest

    (1995)
  • J He et al.

    Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients

    Chest

    (1988)
  • C Guilleminault et al.

    A cause of excessive daytime sleepiness: The upper airway resistance syndrome

    Chest

    (1993)
  • J Lojander et al.

    Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study

    Chest

    (1996)
  • TE Rojewski et al.

    Videoendoscopic determination of the mechanism of obstruction in obstructive sleep apnea

    Otolaryngol Head Neck Surg

    (1984)
  • Shepard JW Jr et al.

    Evaluation of the upper airway in patients with obstructive sleep apnea

    Sleep

    (1991)
  • AR Schwartz et al.

    Effect of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea

    Am Rev Respir Dis

    (1992)
  • SH Launois et al.

    Site of pharyngeal narrowing predicts outcome of urgery for obstructive sleep apnea

    Am Rev Respir Dis

    (1993)
  • AE Sher et al.

    The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome

    Sleep

    (1996)
  • S Fujita et al.

    Surgical correction of anatomical abnormalities in obstructive sleep apnea syndrome: Uvulopalatopharyngoplasty

    Otolaryngol Head Neck Surg

    (1981)
  • Kamami Y-V

    Out-patient treatment of sleep apnea syndrome with CO2 laser: laser-assisted UPPP

    J of Otolaryngology

    (1994)
  • G Djupesland et al.

    Palatopharyngoglossoplasty in the treatment of patients with obstructive sleep apnea syndrome

    Acta Otolaryngol (Stockh)

    (1992)
  • H Miljeteig et al.

    Uvulopalatopharyngoglossoplasty (UPPGP) in the treatment of the obstructive sleep apnea syndrome

    Acta Otolaryngol (Stockh)

    (1992)
  • S Fujita et al.

    Laser midline glossectomy as a treatment for obstructive sleep apnea

    Laryngoscope

    (1991)
  • BT Woodson et al.

    Clinical experience with lingualplasty as part of the treatment of severe obstructive sleep apnea

    Otolaryngol Head Neck Surg

    (1992)
  • BT Woodson et al.

    A multi-institutional study of radiofrequency volumetric tissue reduction for OSAS

    Otolaryngol Head Neck Surg

    (2001)
  • F Chabolle et al.

    Tongue base reduction with hyoepiglottoplasty: A treatment for severe obstructive apnea

    Laryngoscope

    (1999)
  • BT Woodson et al.

    Transpalatal advancement pharyngoplasty for obstructive sleep apnea

    Laryngoscope

    (1993)
  • RW Riley et al.

    Obstructive sleep apnea and the hyoid. A revised surgical procedure

    Otolaryngol Head Neck Surg

    (1994)
  • ED Weitzman et al.

    Quantitative analysis of sleep and sleep apnea before and after tracheostomy in patients with the hypersomnia-sleep apnea syndrome

    Sleep

    (1980)
  • LH Larsson et al.

    Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome

    Laryngoscope

    (1994)
  • C Janson et al.

    Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty

    Arch Otolaryngol Head Neck Surg

    (1997)
  • Lu S-J et al.

    Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty

    J Laryngol Otol

    (1995)
  • RM Esclamado et al.

    Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome

    Laryngoscope

    (1989)
  • L Haavisto et al.

    Complications of uvulopalatopharyngoplasty

    Clin Otolaryngol

    (1994)
  • Y Zohar et al.

    Uvulopalatopharyngoplasty: evaluation of postoperative complications, sequelae, and results

    Laryngoscope

    (1991)

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    Correspondence should be addressed to: A. E. Sher, 6 Executive Park Drive, Albany, NY 12203, USA. Phone: 518-482-9111; Fax: 518-482-6142; E-mail: [email protected]

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