Overview of Surgical Therapies for Obstructive Sleep Apnea: a Concise Review Literature
Keywords:Obstructive sleep apnea; continuous positive airway pressure; epworth sleepiness scale; apnea hypopnea index; respiratory disturbance index
The surgical therapy of Obstructive Sleep Apnea (OSA) requires addressing anatomical obstructions or collapse of the pharyngeal airway by skeletal and soft tissue surgeries. Numerous surgical options have been documented for OSA therapy with varying success. OSA surgery is vital when patients refuse continuous positive airway pressure (CPAP). The aim of this article is to review surgeries for OSA and the effectiveness of each surgery in terms of Epworth sleepiness scale (ESS), Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) reduction.
2. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005;172:1447-51.
3. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O'Connor GT, Resnick HE, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010;182:269-77.
4. Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnoea with myocardial infarction in men. Lancet 1990;336:261-4.
5. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-84.
6. Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 2016;45:43.
7. Chandrashekariah R, Shaman Z, Auckley D. Impact of upper airway surgery on cpap compliance in difficult-to-manage obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 2008;134:926-30.
8. Boyd SB, Walters AS, Waite P, Harding SM, Song Y. Long-term effectiveness and safety of maxillomandibular advancement for treatment of obstructive sleep apnea. J Clin Sleep Med 2015;11:699-708.
9. Bjorvatn B, Rajakulendren N, Lehmann S, Pallesen S. Increased severity of obstructive sleep apnea is associated with less anxiety and depression. J Sleep Res 2018;27:e12647.
10. Li HY, Lee LA, Hsin LJ, Fang TJ, Lin WN, Chen HC, et al. Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea. Biomed J 2019;42:84-92.
11. Koutsourelakis I, Safiruddin F, Ravesloot M, Zakynthinos S, de Vries N. Surgery for obstructive sleep apnea: Sleep endoscopy determinants of outcome. Laryngoscope 2012;122:2587-91.
12. Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011;268:1233-6.
13. Liu SY, Huon LK, Powell NB, Riley R, Cho HG, Torre C, et al. Lateral pharyngeal wall tension after maxillomandibular advancement for obstructive sleep apnea is a marker for surgical success: observations from drug-induced sleep endoscopy. J Oral Maxillofac Surg 2015;73:1575-82.
14. Valero A, Alroy G. Hypoventilation in acquired micrognathia. Arch Intern Med 1965;115:307-10.
15. Guilleminault C, Simmons FB, Motta J, Cummiskey J, Rosekind M, Schroeder JS, et al. Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience. Arch Intern Med 1981;141:985-8.
16. Kuhlo W, Doll E, Franck MC. Successful management of Pickwickian syndrome using long-term tracheostomy. Dtsch Med Wochenschr 1969;94:1286-90.
17. Weitzman ED, Kahn E, Pollak CP. Quantitative analysis of sleep and sleep apnea before and after tracheostomy in patients with the hypersomnia-sleep apnea syndrome. Sleep 1980;3:407-23.
18. El Solh AA, Jaafar W. A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients. Crit Care 2007;11:R3.
19. Hashmi NK, Ransom E, Nardone H, Redding N, Mirza N. Quality of life and self-image in patients undergoing tracheostomy. Laryngoscope 2010;120 Suppl 4:S196.
20. Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010;33:1408-13.
21. Johnson DM, Soose RJ. Updated nasal surgery for obstructive sleep apnea. Adv Otorhinolaryngol 2017;80:66-73.
22. Nakata S, Noda A, Yagi H, Yanagi E, Mimura T, Okada T, et al. Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome. Rhinology 2005;43:296-9.
23. Ikematsu T. Study of snoring, 4th report: therapy. Ther J Jpn Otorhinolaryngol. 1964;64:434-5.
24. Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 1981;89:923-34.
25. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156-77.
26. Värendh M, Berg S, Andersson M. Long-term follow-up of patients operated with uvulopalatopharyngoplasty from 1985 to 1991. Respir Med 2012;106:1788-93.
27. Rosvall BR, Chin CJ. Is uvulopalatopharyngoplasty effective in obstructive sleep apnea? Laryngoscope 2017;127:2201-2.
28. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 2002;127:13-21.
29. Riley RW, Powell NB, Guilleminault C. Obstructive Sleep Apnea Syndrome: A review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 1993;108:117-25.
30. Neruntarat C. Genioglossus advancement and hyoid myotomy under local anesthesia. Otolaryngol Head Neck Surg 2003;129:85-91.
31. Vargo JD, Ogan WS, Tanna N, Stevens D, Andrews BT. Modified genioglossal advancement for isolated treatment of obstructive sleep apnea. J Craniofac Surg 2017;28:1274-7.
32. Kamami YV. Outpatient treatment of sleep apnea syndrome with CO2 laser, LAUP: laser-assisted UPPP results on 46 patients. J Clin Laser Med Surg 1994;12:215-9.
33. Peng Y, Fan J, Wu J, Deng B, Sun A. Evaluate the effect of CO2 laser-assisted uvulopalatopharyngoplasty for obstructive sleep apnea-hypopnea syndrome. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009;23:302-4.
34. Göktas Ö, Solmaz M, Göktas G, Olze H. Long-term results in obstructive sleep apnea syndrome (OSAS) after laser-assisted uvulopalatoplasty (LAUP). PLoS One. 2014;9:e100211.
35. Camacho M, Kushida CA, Lambert E, Nesbitt NB, Song SA, Chang ET, et al. Laser-assisted uvulopalatoplasty for obstructive sleep apnea: a systematic review and meta-analysis. Sleep 2017;40(3). doi: 10.1093/sleep/zsx004.
36. Powell NB, Riley RW, Troell RJ, Li K, Blumen MB, Guilleminault C. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing. Chest 1998;113:1163-74.
37. Powell NB, Riley RW, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study. Otolaryngol Head Neck Surg 1999;120:656-64.
38. Sonsuwan N, Rujimethabhas K, Sawanyawisuth K. Factors associated with successful treatment by radiofrequency treatment of the soft palate in obstructive sleep apnea as the first-line treatment. Sleep Disord 2015;2015 690425.
39. Liu SY, Awad M, Riley RW. Maxillomandibular Advancement: contemporary approach at Stanford. Atlas Oral Maxillofac Surg Clin North Am 2019;27:29-36.
40. Li KK, Powell NB, Riley RW, Zonato A, Gervacio L, Guilleminault C. Morbidly obese patients with severe obstructive sleep apnea: is airway reconstructive surgery a viable treatment option? Laryngoscope 2000;110:982-7.
41. Doff MH, Jansma J, Schepers RH, Hoekema A. Maxillomandibular advancement surgery as alternative to continuous positive airway pressure in morbidly severe obstructive sleep apnea: a case report. Cranio 2013;31:246-51.
42. Camacho M, Teixeira J, Abdullatif J, Acevedo JL, Certal V, Capasso R, et al. Maxillomandibular advancement and tracheostomy for morbidly obese obstructive sleep apnea: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015;152:619-30.
43. Camacho M, Liu SY, Certal V, Capasso R, Powell NB, Riley RW. Large maxillomandibular advancements for obstructive sleep apnea: an operative technique evolved over 30 years. J Cranio-maxillofac Surg 2015;43:1113-8.
44. Abramson Z, Susarla SM, Lawler M, Bouchard C, Troulis M, Kaban LB. Three-dimensional computed tomographic airway analysis of patients with obstructive sleep apnea treated by maxillomandibular advancement. J Oral Maxillofac Surg 2011;69:677-86.
45. Abramson Z, Susarla S, August M, Troulis M, Kaban L. Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. J Oral Maxillofac Surg 2010;68:354-62.
46. Kastoer C, Op de Beeck S, Dom M, Neirinckx T, Verbraecken J, Braem MJ, et al. Drug-induced sleep endoscopy upper airway collapse patterns and maxillomandibular advancement. Laryngoscope 2019 Apr 29. doi: 10.1002/lary.28022. [Epub ahead of print]
47. Li KK, Riley RW, Powell NB, Guilleminault C. Patient's perception of the facial appearance after maxillomandibular advancement for obstructive sleep apnea syndrome. J Oral Maxillofac Surg 2001;59:377-80.
48. Liu SY-C, Lee P-J, Awad M, Riley RW, Zaghi S. Corrective nasal surgery after maxillomandibular advancement for obstructive sleep apnea: experience from 379 cases. Otolaryngol Head Neck Surg 2017;157:156-159.
49. Gu Y, McNamara JA, Jr, Sigler LM, Baccetti T. Comparison of craniofacial characteristics of typical Chinese and Caucasian young adults. Eur J Orthod 2011;33:205-11.
50. Liao YF, Chiu YT, Lin CH, Chen YA, Chen NH, Chen YR. Modified maxillomandibular advancement for obstructive sleep apnoea: towards a better outcome for Asians. Int J Oral Maxillofac Surg 2015;44:189-94.
51. Liu Sr, Yi Hl, Guan J, Chen B, Wu Hm, Yin Sk. Changes in facial appearance after maxillomandibular advancement for severe obstructive sleep apnoea hypopnoea syndrome in Chinese patients: a subjective and objective evaluation. Int J Oral Maxillofac Surg 2012;41:1112-9.
52. Boyd SB, Chigurupati R, Cillo JE, Jr., Eskes G, Goodday R, Meisami T, et al. Maxillomandibular advancement improves multiple health-related and functional outcomes in patients with obstructive sleep apnea: a multicenter study. J Oral Maxillofac Surg 2019;77:352-70.
53. Zaghi S, Holty J-EC, Certal V, Abdullatif J, Guilleminault C, Powell NB, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Head Neck Surg 2016;142:58-66.
54. Schwartz AR, Thut DC, Russ B, Seelagy M, Yuan X, Brower RG, et al. Effect of electrical stimulation of the hypoglossal nerve on airflow mechanics in the isolated upper airway. Am Rev Respir Dis 1993;147:1144-50.
55. Eastwood PR, Barnes M, Walsh JH, Maddison KJ, Hee G, Schwartz AR, et al. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep 2011;34:1479-86.
56. Strollo PJ, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. Upper-Airway Stimulation for Obstructive Sleep Apnea. N Engl J Med 2014;370:139-49.
57. Woodson T, Soose R, Gillespie M, Strohl K, Maurer J, de vries N, et al. Three-Year Outcomes of Cranial Nerve Stimulation for Obstructive Sleep Apnea: The STAR Trial2015. Otolaryngol Head Neck Surg 2016;154:181-8.
58. Friedman M, Schalch P, Lin H-C, Kakodkar KA, Joseph NJ, Mazloom N. Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2008;138:209-16.
59. Choi JH, Kim S-N, Cho JH. Efficacy of the pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: A meta-analysis. Laryngoscope 2013;123:269-76.
60. Vicini C, Dallan I, Canzi P, Frassineti S, La Pietra MG, Montevecchi F. Transoral Robotic Tongue Base Resection in Obstructive Sleep Apnoea-Hypopnoea Syndrome: A Preliminary Report. ORL 2010;72:22-27.
61. Vicini C, Montevecchi F. Transoral Robotic Surgery for Obstructive Sleep Apnea: Past, Present, and Future. Sleep Med Clin 2019;14:67-72.
62. McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med 2016;375:919-31.
63. Rotenberg BW, Vicini C, Pang EB, Pang KP. Reconsidering first-line treatment for obstructive sleep apnea: a systematic review of the literature. J Otolaryngol Head Neck Surg 2016;45:23.
64. Liu SY, Wayne Riley R, Pogrel A, Guilleminault C. Sleep Surgery in the Era of Precision Medicine. Atlas Oral Maxillofac Surg Clin North Am 2019;27:1-5.
65. Liu SY, Riley RW. Continuing the Original Stanford Sleep Surgery Protocol From Upper Airway Reconstruction to Upper Airway Stimulation: Our First Successful Case. J Oral Maxillofac Surg 2017;75:1514-8.
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