Ewha Med J.  2013 Sep;36(2):93-96. 10.12771/emj.2013.36.2.93.

Surgical Management for Obstructive Sleep Apnea Syndrome

• Bae JH
• Lee SS

• KMID: 2171238
• DOI: http://doi.org/10.12771/emj.2013.36.2.93

Abstract

Obstructive sleep apnea syndrome (OSAS) is caused by repetitive upper-airway narrowing or collapse during sleep resulting in hypopneas and apneas. When a patient is diagnosed of OSAS with polysomnogram, he/she should receive upper airway evaluation to find the narrow site. The anatomic narrow site can be nasal cavity, nasopharynx, oropharynx, and/or hypopharynx. Surgical treatment for OSAS should be tailored to the anatomic narrow site. In this article, the authors describe surgical treatment options for OSAS.

Keyword

Apnea; Hypopnea; Obstructive sleep apnea syndrome; Polysomnogram; Surgery

MeSH Terms

Apnea
Humans
Hypopharynx
Nasal Cavity
Nasopharynx
Oropharynx
Polysomnography
Sleep Apnea, Obstructive*

Figure

• 

  Fig. 1 Surgical protocol for patients with OSAS. Surgical treatment options are tailored to the site of obstruction. More invasive surgery is reserved for surgical failure in phase I surgery. This protocol is modified from Stanford protocol [13]. UPPP, uvulopalatopharyngoplasty; GA, genioglossus advancement; HS, hyoid suspension; MMA, maxillomandibular advancement; TBR, tongue base reduction.

Reference

1. Petri N, Suadicani P, Wildschiodtz G, Bjorn-Jorgensen J. Predictive value of Muller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty: evaluation of predictive factors using discriminant analysis in 30 sleep apnea patients. Acta Otolaryngol. 1994; 114:565–571.

2. Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci. 1991; 16:504–509.

3. Lee CH, Hong SL, Rhee CS, Kim SW, Kim JW. Analysis of upper airway obstruction by sleep videofluoroscopy in obstructive sleep apnea: a large population-based study. Laryngoscope. 2012; 122:237–241.

4. Meurice JC, Marc I, Carrier G, Series F. Effects of mouth opening on upper airway collapsibility in normal sleeping subjects. Am J Respir Crit Care Med. 1996; 153:255–259.

5. Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981; 89:923–934.

6. Powell N, Riley R, Guilleminault C, Troell R. A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep. 1996; 19:593–599.

7. Kim TH, Koo SK, Han CW, Kim YC, Ahn GY. Palatal muscle resection (PMR) for the treatment of snoring patients. Korean J Otorhinolaryngol-Head Neck Surg. 2008; 51:1119–1123.

8. Li HY, Lee LA. Relocation pharyngoplasty for obstructive sleep apnea. Laryngoscope. 2009; 119:2472–2477.

9. Riley RW, Powell NB, Guilleminault C, Nino-Murcia G. Maxillary, mandibular, and hyoid advancement: an alternative to tracheostomy in obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 1986; 94:584–588.

10. Riley RW, Powell NB, Guilleminault C. Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg. 1986; 94:589–593.

11. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg. 1994; 111:717–721.

12. Goh YH, Lim KA. Modified maxillomandibular advancement for the treatment of obstructive sleep apnea: a preliminary report. Laryngoscope. 2003; 113:1577–1582.

13. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg. 1993; 108:117–125.