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Semin Respir Crit Care Med 2005; 26(1): 80-88
DOI: 10.1055/s-2005-864201
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Therapy for Obstructive Sleep Apnea Syndrome

Kasey K. Li1
  • 1Stanford Sleep Disorders Clinic and Research Center, Stanford University, Stanford, California
Further Information

Publication History

Publication Date:
22 February 2005 (online)

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ABSTRACT

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review presents the current state of the art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiography, formulation of a surgical plan with selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.

KEYWORDS

Obstructive sleep apnea - sleep apnea surgery - uvulopalatopharyngoplasty - uvulopalatal flap - maxillomandibular advancement - genioglossus advancement - hyoid advancement - radiofrequency - somnoplasty

REFERENCES

  • 1 Guilleminault C, Tilkian A, Dement W C. The sleep apnea syndromes.  Annu Rev Med. 1976;  27 465-484
    CrossrefPubMedGoogle Scholar
  • 2 Nieto F J, Young T B, Lind B K et al.. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study.  JAMA. 2000;  283 1829-1836
    CrossrefPubMedGoogle Scholar
  • 3 Peppard P E, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered brething and hypertension.  N Engl J Med. 2000;  342 1378-1384
    CrossrefPubMedGoogle Scholar
  • 4 Peker Y, Kraiczi H, Hedner J, Loth S, Johansson A, Bende M. An independent association between obstructive sleep apnoea and coronary artery disease.  Eur Respir J. 1999;  14 179-184
    CrossrefPubMedGoogle Scholar
  • 5 Shamsuzzaman A S, Somers V K. Fibrinogen, stroke, and obstructive sleep apnea: an evolving paradigm of cardiovascular risk [editorial].  Am J Respir Crit Care Med. 2000;  162 2018-2020
    PubMedGoogle Scholar
  • 6 Gottlieb D J, Whitney C W, Bonekat W H et al.. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study.  Am J Respir Crit Care Med. 1999;  159 502-507
    PubMedGoogle Scholar
  • 7 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;  328 1230-1235
    CrossrefPubMedGoogle Scholar
  • 8 Kribbs N B, Redline S, Smith P L et al.. Objective monitoring of nasal CPAP usage in OSAS patients.  Sleep Res. 1991;  20 270-271
    PubMedGoogle Scholar
  • 9 Reeves-Hoche M K, Meck R, Zwillich C W. Nasal CPAP: an objective evaluation of patient compliance.  Am J Respir Crit Care Med. 1994;  149 149-154
    PubMedGoogle Scholar
  • 10 Waldhorn R E, Herrick T W, Nguyen M C et al.. Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea.  Chest. 1991;  99 855-860
    PubMedGoogle Scholar
  • 11 Grote L, Hedner J, Grunstein R, Kraiczi H. Therapy with nCPAP: imcomplete elimination of sleep related breathing disorder.  Eur Respir J. 2000;  16 921-927
    CrossrefPubMedGoogle Scholar
  • 12 Fijita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic abnormalities of obstructive sleep apnea syndrome: uvulopalatopharyngoplasty.  Otolaryngol Head Neck Surg. 1981;  89 923-934
    CrossrefPubMedGoogle Scholar
  • 13 Sher A E, Schechtman K B, Piccirillo J F. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome.  Sleep. 1996;  19 156-177
    PubMedGoogle Scholar
  • 14 Schwab R J, Gefter W B, Hoffman E A, Gupta K B, Pack A I. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing.  Am Rev Respir Dis. 1993;  148 1385-1400
    PubMedGoogle Scholar
  • 15 Haponik E F, Smith P L, Bohlman M E, Allen R P, Goldman S M, Bleecker E R. Computerized tomography in obstructive sleep apnea.  Am Rev Respir Dis. 1983;  127 221-226
    PubMedGoogle Scholar
  • 16 Suto Y, Matsuo T, Kato T et al.. Evaluation of pharyngeal airway in patients in sleep apnea: value of Ultrafast MR imaging.  AJR Am J Roentgenol. 1993;  160 311-314
    PubMedGoogle Scholar
  • 17 Schwab R J, Gupta K B, Gefter W B et al.. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing.  Am J Respir Crit Care Med. 1995;  152 1673-1689
    PubMedGoogle Scholar
  • 18 Jamieson A, Guilleminault C, Partinen M, Quera-Salva M A. Obstructive sleep apnea patients have craniomandibular abnormalities.  Sleep. 1986;  9 469-477
    PubMedGoogle Scholar
  • 19 Partinen M, Guilleminault C, Quera-Salva M, Jamieson A. Obstructive sleep apnea and cephalometric roentgenograms.  Chest. 1988;  93 1199-1205
    CrossrefPubMedGoogle Scholar
  • 20 Li K K, Powell N B, Riley R W et al.. Morbidly obese patients with severe obstructive sleep apnea syndrome: is airway reconstructive surgery a viable option?.  Laryngoscope. 2000;  110 982-987
    PubMedGoogle Scholar
  • 21 Sher A E, Thorpy M J, Shrintzen R J et al.. Predictive value of Muller maneuver in selection of patient for uvulopalatopharyngoplasty.  Laryngoscope. 1985;  95 1483-1487
    PubMedGoogle Scholar
  • 22 Aboussouan L S, Golish J A, Wood B G, Mehta A C, Wood D E, Dinner D S. Dynamic pharyngoscopy in predicting outcome of uvulopalatopharyngopasty for moderate and severe obstructive sleep apnea.  Chest. 1995;  107 946-951
    PubMedGoogle Scholar
  • 23 Lofaso F, Coste A D, Ortho M P et al.. Nasal obstruction as a risk factor sleep apnea syndrome.  Eur Respir J. 2000;  16 639-643
    CrossrefPubMedGoogle Scholar
  • 24 Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population based cohort study.  Arch Intern Med. 2001;  161 1514-1519
    CrossrefPubMedGoogle Scholar
  • 25 Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group.  J Allergy Clin Immunol. 1997;  99 S757-S762
    PubMedGoogle Scholar
  • 26 Friedman M, Tanyeri H, Lim J W, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of improved nasal breathing on obstructive sleep apnea.  Otolaryngol Head Neck Surg. 2000;  122 71-74
    PubMedGoogle Scholar
  • 27 Verse T, Maurer J T, Pirsig W. Effect of nasal surgery on sleep-disordered breathing disorders.  Laryngoscope. 2002;  112 64-68
    PubMedGoogle Scholar
  • 28 Powell N B, Riley R W, Guilleminault C, Troell R J. A reversible uvulopalatal flap for snoring and obstructive sleep.  Sleep. 1996;  19 593-599
    PubMedGoogle Scholar
  • 29 Li K K, Riley R W, Powell N B, Troell R J. Obstructive sleep apnea surgery: genioglossus advancement revisited.  J Oral Maxillofac Surg. 2001;  59 1181-1184
    CrossrefPubMedGoogle Scholar
  • 30 Li K K, Powell N B, Riley R W, Troell R J, Guilleminault C. Overview of Phase I surgery for Obstructive sleep apnea syndrome.  Ear Nose Throat J. 1999;  78 836-845
    PubMedGoogle Scholar
  • 31 Lee N R, Givens Jr C D, Wilson J, Robins R B. Staged surgical treatment of obstructive sleep apnea syndrome: a review of 35 patients.  J Oral Maxillofac Surg. 1999;  57 382-385
    CrossrefPubMedGoogle Scholar
  • 32 Bettega G, Pepin J, Veale D et al.. Obstructive sleep apnea syndrome: fifty-one consecutive patients treated by maxillofacial surgery.  Am J Respir Crit Care Med. 2000;  162 641-649
    PubMedGoogle Scholar
  • 33 Hsu P P, Brett R H. Multiple level pharyngeal surgery for obstructive sleep apnoea.  Singapore Med J. 2001;  42 160-164
    PubMedGoogle Scholar
  • 34 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea and the hyoid: a revised surgical procedure.  Otolaryngol Head Neck Surg. 1994;  111 717-721
    PubMedGoogle Scholar
  • 35 Neruntarat C. Genioglossus advancement and hyoid myotomy under local anesthesia.  Otolaryngol Head Neck Surg. 2003;  129 85-91
    CrossrefPubMedGoogle Scholar
  • 36 Li K K, Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea and maxillomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinationa.  J Oral Maxillofac Surg. 2002;  60 526-530
    CrossrefPubMedGoogle Scholar
  • 37 Li K K, Riley R W, Powell N B et al.. Obstructive sleep apnea surgery: patients' perspective and polysomnographic results. Otolaryngol Head Neck Surg 2000 123: 572-575
    Google Scholar
  • 38 Li K K, Powell N B, Riley R W, Troell R J, Guilleminault C. Overview of phase II surgery for obstructive sleep apnea syndrome.  ENT J. 1999;  78 851-857
    PubMedGoogle Scholar
  • 39 Li K K, Powell N B, Riley R W et al.. Long-term results of maxillomandibular advancement surgery.  Sleep Breath. 2000;  4 137-139
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Conradt R, Hochban W, Brandenburg U, Heitmann J, Peter J H. Long-term results after surgical treatment of obstructive sleep apnea by maxillomandibular advancement.  Eur Respir J. 1997;  10 123-128
    CrossrefPubMedGoogle Scholar
  • 41 Seto B H, Gotsopaulos H, Sims M R, Cistulli P A. Maxillary morphology in obstructive sleep apnea syndrome.  Eur J Orthod. 2001;  23 703-714
    PubMedGoogle Scholar
  • 42 Kushida C, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome.  Ann Intern Med. 1997;  127 581-587
    CrossrefPubMedGoogle Scholar
  • 43 Cistulli P A, Richards G N, Palmisano R G, Unger G, Berthon-Jones M, Sullivan C E. Influence of maxillary constriction on nasal resistance and sleep apnea severity in patients with Marfan's syndrome.  Chest. 1996;  110 1184-1188
    PubMedGoogle Scholar
  • 44 Timms D J. Rapid maxillary expansion in the treatment of nocturnal enuresis.  Angle Orthod. 1990;  60 229-233
    PubMedGoogle Scholar
  • 45 Kurol J, Modin H, Bjerkhoel A. Orthodontic maxillary expansion and its effect on nocturnal enuresis.  Angle Orthod. 1998;  68 225-232
    PubMedGoogle Scholar
  • 46 Cistulli P A, Palmisano R G, Poole M D. Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion.  Sleep. 1998;  21 831-835
    PubMedGoogle Scholar
  • 47 Guilleminault C, Li K K. Maxillomandibular expansion by distraction osteogenesis for the treatment of sleep-disordered breathing: preliminary results.  Laryngoscope. 2004;  114 893-896
    CrossrefPubMedGoogle Scholar
  • 48 Powell N B, Riley R W, Troell R J et al.. Radiofrequency volumetric reduction of the tongue.  Chest. 1997;  111 1348-1355
    PubMedGoogle Scholar
  • 49 Powell N B, Riley R W, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study.  Otolaryngol Head Neck Surg. 1999;  120 656-664
    CrossrefPubMedGoogle Scholar
  • 50 Li K K, Powell N B, Riley R W, Guilleminault C. Temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing: long-term follow-up.  Otolaryngol Head Neck Surg. 2002;  127 230-234
    CrossrefPubMedGoogle Scholar
  • 51 Stuck B A, Maurer J T, Verse T, Hormann K. Tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction for treatment of obstructive sleep apnea syndrome.  Acta Otolaryngol. 2002;  122 531-536
    CrossrefPubMedGoogle Scholar
  • 52 Tucker B T, Nelson L, Mickelson S, Huntley T, Sher A. A multi-institutional study of radiofrequency volumetric tissue reduction for OSAS.  Otolaryngol Head Neck Surg. 2001;  125 303-311
    CrossrefPubMedGoogle Scholar
  • 53 Fischer Y, Khan M, Mann W J. Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea.  Laryngoscope. 2003;  113 1786-1791
    PubMedGoogle Scholar
  • 54 Steward D L, Weaver E M, Woodson B T. A comparison of radiofrequency treatment schemes for obstructive sleep apnea syndrome.  Otolaryngol Head Neck Surg. 2004;  130 579-585
    CrossrefPubMedGoogle Scholar
  • 55 Woodson B T, Steward D L, Weaver E M, Javaheri S. A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome.  Otolaryngol Head Neck Surg. 2003;  128 848-861
    CrossrefPubMedGoogle Scholar

Kasey K LiM.D. D.D.S. F.A.C.S. 

Stanford Sleep Disorders Clinic and Research Center

Stanford University, 1900 University Ave

Ste. #105, East Palo Alto, CA 94303

Email: drli@sleepapneasurgery.com

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