Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults

Aurora, R. Nisha; Casey, Kenneth R.; Kristo, David A.; Auerbach, Sanford H.; Bista, Sabin R.; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; R, Zák; Morgenthaler, Timothy I.; Tracy, Sharon L.

doi:10.1093/sleep/33.10.1408

Cited by 297 publications

(252 citation statements)

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“…In addition to being the most conservative approach, it may be helpful as a noninvasive means to determine the likelihood of improvement of symptoms after surgery, and to minimize the chance of perioperative complications [17]. In addition, patient counseling should also include behavioral modifications, such as weight loss, diet, physical exercise, positional therapy, and avoidance of sedatives, regardless of the treatment option chosen [18].…”

Section: Presurgical Evaluationmentioning

confidence: 99%

“…Other goals of surgery include normalization of sleep quality, improvement of the AHI and oxygen saturation levels [18]. A bed partner's complaints of snoring should also be remembered as an important outcome [21].…”

Section: Objectivesmentioning

confidence: 99%

“…Therefore, the surgeon should be familiar with each procedure to determine the appropriate surgical plan. Patient counseling in regard to success rates and potential complications of each modality of surgery is recommended [18,22].…”

Section: Objectivesmentioning

confidence: 99%

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Surgical Therapy of Obstructive Sleep Apnea: A Review

2012

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Obstructive sleep apnea (OSA) is a disease characterized by intermittent and repetitive narrowing of the airway during sleep. Surgical therapies for the treatment of OSA aim to improve airway patency by addressing selected site(s) of obstruction. Because several areas may each be responsible for the narrowing, different surgical modalities have also been developed. In this review, we give an overview of surgery for each of potential obstruction site(s). As a consequence of the multi-factorial and heterogeneous etiology of OSA, surgical therapies need to be selected and performed specifically for each patient, as there is no perfect surgery that will fit all patients. As with any other treatment modalities for OSA, surgical therapies have variable efficacy, but are a very important tool on OSA management in selected patients and have been shown effectiveness in decreasing the morbidity and mortality associated with the disease.

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Section: Presurgical Evaluationmentioning

confidence: 99%

Section: Objectivesmentioning

confidence: 99%

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Surgical Therapy of Obstructive Sleep Apnea: A Review

2012

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“…[9] Evaluation for surgery may include physical examination, fiberoptic endoscopy, and Müller maneuver, but more extensive methods of evaluating the upper airway may not be available or feasible because of time constraints on examination. [10,11] Previous studies have evaluated the relation between upper airway examination and severity of OSAHS. [8,12,13] Although previous studies have compared the predictive value of physical findings with polysomnography, limited information is available about the effect of obesity on the upper airway physical findings.…”

mentioning

confidence: 99%

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Avci¹,

Lakadamyalı²,

Büyüklü³

et al. 2017

Kulak Burun Bogaz Ihtis Derg

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Objectives: This study aims to evaluate anatomic abnormalities that may be associated with obesity and may cause sleep apnea in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by physical examination and Müller maneuver. Patients and Methods:This single center, prospective, cross-sectional study included 330 OSAHS patients (274 males, 56 females; mean age 47±11 years; range 17 to 79 years) who were performed polysomnography. Patients' clinical history as well as otolaryngology examination findings including pharyngeal soft tissues, anterior rhinoscopy and Müller maneuver were recorded. Results:Mean body mass index (BMI) was 32±5 kg/m 2 (range 21.9 to 48.4 kg/m 2 ) and apnea-hypopnea index (AHI) was 27±24 episodes per hour (range 0 to 106 episodes/hour). The AHI and BMI were statistically significantly correlated with minimum oxygen saturation, neck circumference, waist circumference, Epworth Sleepiness Scale score, retropalatal and retroglossal grades, tonsil size, and modified Mallampati score. Patients with higher AHI or BMI had statistically significantly higher retropalatal, retroglossal, and combined retropalatal and retroglossal grades (p≤0.001). Conclusion:Obesity affects the retropalatal and retroglossal grades and modified Mallampati scores of patients with OSAHS. High scores of those variables with low BMI may be attributed to upper airway soft tissue or craniofacial bony abnormalities. The retropalatal airway may narrow earlier than the retroglossal airway when fat accumulation starts in the lateral pharyngeal walls and tongue.Keywords: Müller maneuver; obesity; obstructive sleep apnea. ) ve apne-hipopne indeksi saatte 27±24 epizod (dağılım 0-106 epizod/saat) idi. Apne-hipopne indeksi ve VKİ; minimum oksijen satürasyonu, boyun çevresi, karın çevresi, Epworth Uykululuk Skalası skoru, retropalatal ve retroglossal evre, tonsil büyüklüğü ve modifiye Mallampati skoru ile istatistiksel olarak anlamlı şekilde ilişkiliydi. Apne-hipopne indeksi veya VKİ'si daha yüksek olan hastalar istatistiksel olarak daha yüksek retropalatal, retroglossal ve kombine retropalatal ve retroglossal evreye sahipti (p≤0.001).Sonuç: Obezite, OUAHS'li hastaların retropalatal ve retroglossal evrelerini ve modifiye Malampati skorlarını etkiler. Bu değişkenlere ait skorların yüksek, VKİ'nin düşük olması, üst solunum yolu yumuşak doku veya kraniyofasiyal kemik anormalliklerine bağlanabilir. Lateral farengeal duvarlarda ve dilde yağ birikimi başladığında retropalatal hava yolu, retroglossal hava yolundan önce daralabilir.Anahtar Sözcükler: Müller manevrası; obezite; obstrüktif uyku apnesi.

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“…1,2 In a recent practice parameter from 2010, the American Academy of Sleep Medicine (AASM) stated, "There is a pressing need for comparative outcomes research regarding UPPP and other treatment modalities, as the benefi ts compared with harms of UPPP are unclear at this time." 3 In this context, Tan et al present the results of a cost effectiveness analysis (CEA) of palatopharyngoplasty reconstructive surgery (PPRS) and multilevel surgery (MLS) for CPAP intolerant patients in a hypothetical cohort of 50-yearold men with severe OSA (i.e., AHI > 30/hour). 4 This analysis does not address the uncertainty regarding the clinical long-term effectiveness of surgery for OSA.…”

mentioning

confidence: 99%