eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Palatal & Maxillofacial Surgery

Snoring and Obstructive Sleep Apnea, Surgery: Follow-up

Author: Jonathan P Lindman, MD, Consulting Staff, Department of Otolaryngology, ENT Care Associates
Coauthor(s): Charles E Morgan, DMD, MD, Assistant Professor, Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham
Contributor Information and Disclosures

Updated: Sep 25, 2009

Outcome and Prognosis

Most investigators define successful treatment as a decrease of 50% in the respiratory disturbance index (RDI) and a decrease in this number to less than 20 on postpolysomnography. Other, less objective measures include an improvement in the patient’s energy level and ability to concentrate.

The 59% surgical success rate of multilevel temperature-controlled radiofrequency tissue ablation (TCRFTA) in the study by Steward was comparable with published success rates of 50% with uvulopalatopharyngoplasty (UPPP) and tongue-base TCRFTA and published success rates of 42-59% with UPPP and midline glossectomy. The published success rate with UPPP and genioglossus advancement is 35-77%, with or without hyoid myotomy and suspension. The published success rates of 90% or more with combined UPPP, genioglossus advancement, and maxillary-mandibular advancement are most impressive.

Patients at less than 125% of their ideal body weight are most likely to have short-term and long-term benefits from surgical treatment of snoring and obstructive sleep apnea (OSA). Other important variables include severity of disease, age at onset of symptoms, and comorbidities.

Patients with mild obstructive disease are more likely to respond to surgical treatment than those with more severe disease.

Outcome data from numerous studies have demonstrated significant short-term benefits from the aforementioned surgical procedures in appropriately selected patients. Additional efforts also affect the long-term results and prognosis for patients.

Future and Controversies

Surgical treatment of obstructive sleep apnea (OSA) is an option in affected patients who cannot tolerate continuous positive airway pressure (CPAP). As noted above, many procedures are available, but uvulopalatopharyngoplasty (UPPP) is the most frequently performed procedure. Further investigation of the pathophysiology of OSA and the long-term efficacy of current surgical therapy is indicated and ongoing.

A growing number of reports in the literature demonstrate an ongoing commitment among scientists and physicians to improve our understanding of sleep-disordered breathing. In addition, in the United States alone, the Stanford Sleep Disorders clinic conducts a fellowship to train physicians in the subspecialty of sleep disorders. The AmericanAcademy of Sleep Medicine specifically promotes the advancement of sleep medicine and better health among those who have sleep-disordered breathing.

 


More on Snoring and Obstructive Sleep Apnea, Surgery

Overview: Snoring and Obstructive Sleep Apnea, Surgery
Workup: Snoring and Obstructive Sleep Apnea, Surgery
Treatment: Snoring and Obstructive Sleep Apnea, Surgery
Follow-up: Snoring and Obstructive Sleep Apnea, Surgery
Multimedia: Snoring and Obstructive Sleep Apnea, Surgery
References
Further Reading
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References

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Further Reading

Clinical guidelines

University of Texas, School of Nursing, Family Nurse Practitioner Program. Screening for obstructive sleep apnea in the primary care setting. Austin (TX): University of Texas, School of Nursing; 2006 May. 13 p.

Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of obstructive sleep apnea in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Jun. 55 p.

Scottish Intercollegiate Guidelines Network (SIGN). Management of obstructive sleep apnoea/hypopnoea syndrome in adults. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2003 Jun. 35 p.

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Keywords

snoring and obstructive sleep apnea, obstructive sleep apnea, snoring, surgery for obstructive sleep apnea, OSA, surgery for sleep-disordered breathing, obstructive apnea, peripheral apnea, sleep apnea, sleep-induced apnea, Ondine curse, Ondine's curse, frequent awakening, daytime sleepiness, sleep disorder, apnea index, respiratory disturbance index, RDI, uvulectomy, nasal reconstruction, adenotonsillectomy, palatal implants, uvulopalatopharyngoplasty, UPPP, UP3, genioglossal advancement with hyoid myotomy, maxillary-mandibular advancement, bimaxillary advancement, palatal advancement, tongue-base surgery, midline glossectomy, tracheostomy, continuous positive airway pressure, CPAP, bilevel positive airway pressure, Bi-PAP, Pillar system, Pillar procedure, transpalatal advancement pharyngoplasty, thyrohyoid suspension, radiofrequency ablation, tracheotomy

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Contributor Information and Disclosures

Author

Jonathan P Lindman, MD, Consulting Staff, Department of Otolaryngology, ENT Care Associates
Jonathan P Lindman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Phi Beta Kappa, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Charles E Morgan, DMD, MD, Assistant Professor, Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham
Charles E Morgan, DMD, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Hassan H Ramadan, MD, MSc, Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University
Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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