Surgical management of obstructive sleep apnoea: A position statement of the Australasian Sleep Association^*

Abstract

Surgery for adult obstructive sleep apnoea (OSA) plays a key role in contemporary management paradigms, most frequently as either a second‐line treatment or in a facilitatory capacity. This committee, comprising two sleep surgeons and three sleep physicians, was established to give clarity to that role and expand upon its appropriate use in Australasia. This position statement has been reviewed and approved by the Australasian Sleep Association (ASA) Clinical Committee.

Is drug‐induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta‐analysis

“…32 It can also be interpreted that, considering that there has been no consensus on DISE indication since its introduction 33 and given that DISE does not seem to be associated with better surgical outcomes, DISE might be optional as a first-line setting before OSA surgery in case of PAP/MAD failure, as advocated by some authors. 34 Hence, the added value of DISE may lie in patients in whom a first upper airway surgery for OSA has failed, and the utility of DISE in this scenario should be investigated. Of note, all associations and confidence intervals were in favour of DISE, but none reached statistical significance.…”

“…Further, the role of DISE may not lie in directing surgical indication but in identifying surgical contra‐indication, such as complete concentric collapse in hypoglossal stimulation 32 . It can also be interpreted that, considering that there has been no consensus on DISE indication since its introduction 33 and given that DISE does not seem to be associated with better surgical outcomes, DISE might be optional as a first‐line setting before OSA surgery in case of PAP/MAD failure, as advocated by some authors 34 . Hence, the added value of DISE may lie in patients in whom a first upper airway surgery for OSA has failed, and the utility of DISE in this scenario should be investigated.…”

A Scoping Review of Sleep Apnea: Where Do We Stand?

“…Generally, surgical indications include an AHI of higher than 15, oxyhemoglobin desaturation less than 90%, and cardiac abnormalities associated with OSA. However, it can also be elected if deemed a risk factor for motor vehicle accidents, failed compliance, or intolerance to previous therapies, and polysomnographic parameters of disease [ 96 ].…”

Contemporary Concise Review 2020: Sleep

“…13 These findings form part of the basis for the recent recommendation of the Australasian Sleep Association that surgery should be considered as a second-line treatment in those who fail or do not wish to utilize device therapy. 14 For several years, the Inspire™ system (Inspire Medical Systems) has been the only commercially available hypoglossal nerve stimulator available. 15 Eastwood et al report on a novel bilateral hypoglossal nerve stimulator, the Genio™ system (Nyxoah), that delivers stimulation through a small, implanted electrode activated by an externally worn system.…”