Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) is a common disease in adults, which influences human relations, quality of life and associates with major complications. Continuous positive airway pressure (CPAP) is the gold standard treatment modality in OSA patients. For patients incompliant or unwilling to CPAP therapy, surgery is an alternative treatment. Sleep surgery for OSA include intrapharyngeal surgery, extrapharyngeal surgery and bariatric surgery addressing upper airway soft tissue, maxillofacial bone, and obesity, respectively. Among sleep surgeries, intrapharyngeal surgery (soft tissue surgery) is widespread used and serves overwhelming majority in OSA surgical patients. Despite the popularity of intrapharyngeal surgery, its outcomes can be influenced by multiple factors and consequently need conjunctive remedy to enhance at the short-term and sustain in the long-term. In this article, we introduce updated indications for treating OSA, practical principle in decision-making between CPAP and surgery, hybrid procedures in treating obstruction at the nose, palate, tongue and epiglottis, and postoperative integrated treatment including oropharyngeal myofunctional therapy (local), positional therapy (regional), and body weight reduction (systemic), and circadian rhythm (central). In summary, intrapharyngeal surgery is a target-oriented procedure that needs to be performed precisely and combines with integrated treatment as a holistic care for OSA patients.

Snoring Sound Characteristics are Associated with Common Carotid Artery Profiles in Patients with Obstructive Sleep Apnea

“…Noteworthily, CPAP is the first-line treatment for moderate-to-severe OSA; 61 surgical intervention is an alternative treatment for patients who are incompliant or unwilling to CPAP therapy. 62 Third, the sample size was relatively small for multivariate regression models with a lot of variables. In this study, qualitative external information for selection and estimation was used to reduce overfit models in small data sets.…”

Parapharyngeal fat pad area at the subglosso-supraglottic level is associated with corresponding lateral wall collapse and apnea-hypopnea index in patients with obstructive sleep apnea: a pilot study

“…The study recruited 41 adult patients who were diagnosed OSA by polysomnography at the Department of Otorhinolaryngology Head and Neck Surgery in Linkou Chang Gung Memorial Hospital (Taoyuan, Taiwan) between May 2013 and October 2015. All of the patients were either intolerant or unwilling to use long term continuous positive airway pressure therapy and sought to undergo intrapharyngeal upper airway surgery for OSA 10,11 . A dynamic drug-induced sleep CT was arranged in order to apply adequate surgical techniques to each patient based on his/her anatomic structure and collapse area 10,12 .…”

Overview of Surgical Therapies for Obstructive Sleep Apnea: a Concise Review Literature

“…10 Some forms of obstructions or collapse occur as a result of a narrowing of certain anatomical sites such as the lateral pharyngeal wall or tongue during sleep. 10 Complete concentric collapse of the velum during sleep is one of the main determinants of failure of OSA surgery. 11 Therefore, drug induced sleep endoscopy (DISE) has become vital for selecting the right treatment plan in OSA cases.…”