ADULT SLEEP APNEA

Obstructive Sleep Apnea (OSA) is a common disorder involving collapse of the upper airway during sleep. This repetitive collapse results in sleep fragmentation, hypoxemia, hypercapnia and increased sympathetic activity. As specialists in upper airway anatomy, physiology and surgery, Otolaryngologists are uniquely qualified to treat patients with OSA. In the Clinical Guidelines for Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults, it is recommended that evaluation for primary surgical treatment be considered in select patients who have severe obstructing anatomy that is surgically correctible (e.g., tonsillar hypertrophy obstructing the pharyngeal airway) and in patients in whom continuous positive airway pressure (CPAP) therapy is inadequate.

Surgical treatment of pediatric sleep disordered breathing with tonsillectomy and adenoidectomy is the recommended first line treatment. In the pediatric population, resolution of OSA occurs in 82% of patients who are treated with tonsillectomy and adenoidectomy.

In most patients with moderate to severe OSA, continuous positive airway pressure (CPAP) is the first line treatment. Successful long term treatment of OSA with CPAP is difficult to achieve and fewer than 50% of patients on CPAP are adequately treated (as defined by 4 hours of use 70% of nights). Other treatment options must be available to patients with OSAS.

Surgical procedures may be considered as a secondary treatment for OSA when the outcome of PAP therapy is inadequate, such as when the patient is intolerant of CPAP or CPAP therapy is unable to eliminate OSA. Surgery may also be considered as a secondary therapy when there is an inadequate treatment outcome with an oral appliance (OA), when the patient is intolerant of the OA or the OA therapy provides unacceptable improvement of clinical outcomes of OSA. Surgery may also be considered as an adjunct therapy when obstructive anatomy or functional deficiencies compromise other therapies or to improve tolerance of other OSA treatments. Surgery for OSAS has been shown to improve important clinical outcomes including survival and quality of life.