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Surgical treatment of obstructive sleep apnea in adults

Authors
Edward M Weaver, MD, MPH
Vishesh K Kapur, MD, MPH
Section Editor
Nancy Collop, MD
Deputy Editor
April F Eichler, MD, MPH

INTRODUCTION

Obstructive sleep apnea (OSA) is a disorder characterized by obstructive apneas and hypopneas due to repetitive collapse of the upper airway during sleep. Untreated OSA is associated with symptoms of excessive daytime sleepiness, impaired daytime function, metabolic dysfunction, and an increased risk of cardiovascular disease and mortality.

In most adults, first-line therapy for OSA consists of behavioral modification, including weight loss if appropriate, and positive airway pressure (PAP) therapy [1-3]. For patients who fail or do not tolerate PAP therapy, treatment options include oral appliances and surgical therapy. The choice among various second-line options depends on the severity of the OSA and the patient's anatomy, risk factors, and preferences.

Surgical treatment of OSA includes a wide array of procedures and approaches that enlarge and/or stabilize the upper airway. These procedures can be categorized as nasal, upper pharyngeal, lower pharyngeal, and global upper airway procedures. Careful patient and procedure selection, especially related to the anatomy, physiology, and function of the upper aerodigestive tract, and perioperative risk management are important considerations in the surgical evaluation of patients with OSA.

This topic will review the roles of surgery in the management of OSA, appropriate patient and procedure selection, and types of upper airway surgery used in the treatment of OSA. The diagnosis and management of OSA more generally are discussed elsewhere. (See "Overview of obstructive sleep apnea in adults" and "Clinical presentation and diagnosis of obstructive sleep apnea in adults" and "Management of obstructive sleep apnea in adults" and "Oral appliances in the treatment of obstructive sleep apnea in adults".)

ROLES OF SURGERY

Surgery is usually reserved as a second-line therapy for obstructive sleep apnea (OSA), either as salvage therapy in patients with OSA who cannot adhere to continuous positive airway pressure (CPAP) or as adjunctive therapy along with CPAP or an oral appliance. Surgery is rarely indicated as primary therapy in adults; this contrasts with children, in whom adenotonsillectomy is generally considered first-line therapy for moderate-to-severe disease in the presence of adenotonsillar hypertrophy. (See "Management of obstructive sleep apnea in children".)

                          

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