OSA Upper Airways Surgery: A Targeted Approach

Abstract

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings

“…Treatment that consisted of CPAP therapy, surgery, or a combination of both was given once patients had completed the OCT examination. Each treatment was specifically chosen according to the patient's AHI, comorbidity, physical examination, body mass index (BMI), and preference, following current guidelines [5,38,39].…”

Head-Of-Bed Elevation (HOBE) for Improving Positional Obstructive Sleep Apnea (POSA): An Experimental Study

“…Obstructive sleep apnea (OSA) syndrome is one of the most common sleep-disorder breathing (SDB) conditions. It is characterized by the reduction (hypopnea) or complete cessation (apnea) of airflow in the upper airways during the night [ 1 , 2 , 3 ]. In some OSA patients, the frequency and duration of apneas could be influenced by head and body positions that are traditionally considered to be supine, prone, or lateral decubitus.…”

Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment

“…The OSA manifests with a reduction (hypopnea) or complete cessation (apnea) of airflow in the upper airways, associated with breathing effort. OSA is a frequent and often underestimated pathology affecting between 2 and 5% of the middle-aged population [ 1 , 2 , 3 , 4 ]. Typical nocturnal symptoms are persistent snoring and awakenings with a dyspnea sensation.…”

“…During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO2) with a gradual increase in carbon dioxide (PaCO2) [ 1 , 5 , 10 , 11 ]. The direct consequence of the intermittent hypoxia could be an oxidative imbalance, with reactive oxygen species production and an inflammatory cascade activation with pro-inflammatory cytokines growth (IL2, IL4, TNF, PCR).…”

“…Furthermore, an endothelial dysfunction, as indicated by increased serum levels of ET-1 and LOX-112-14, could occur. As a result of the nocturnal hypoxia and the systemic inflammations, the risks of the cardiovascular and cerebrovascular morbidities increase [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”