Citation Information :
Thuler E, Yui MS, Junior VS, Tominaga QE, Rabelo F. Obstructive Sleep Apnea Surgical Options: A Phenotypical Approach. Int J Head Neck Surg 2019; 10 (3):62-66.
As a consequence of being a multifactorial disease, multiple mechanisms are involved in OSA pathophysiology, including not only anatomical causes but also causes related to the muscular response during sleep and its effect on pharyngeal wall resistance, both predisposing the upper airway to collapse.
The scientific evidence for OSA surgical treatment suggests that it must be indicated in well-selected cases, mostly in patients presenting anatomical causes, either by tissue hypertrophy or by craniofacial deformities.
Electrical stimulation of the hypoglossal nerve presents promising results, reinforcing the role of the muscular response in OSA pathophysiology.
The greatest challenge in choosing the best surgical treatment option is to define the predominant factor in each candidate, concept called phenotype, which explains the existence of numerous surgical options, presented in a comprehensive way in this paper.
Tufik S, Santos-Silva R, et al. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep medicine. 2010;11(5).
Shahar E, Whitney CW, et al. Sleep-disordered breathing and cardiovascular disease: Cross-sectional results of the sleep heart health study. American Journal of Respiratory and Critical Care Medicine. 2001;163(1).
Punjabi NM, Caffo BS, et al. Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Medicine. 2009;6(8).
Epstein LJ, Kristo D, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2009;5(3).
Pieters T, Collard P, et al. Acceptance and long-term compliance with nCPAP in patients with obstructive sleep apnoea syndrome. European Respiratory Journal. 1996;9(5).
Collard P, Pieters T, et al. Compliance with nasal CPAP in obstructive sleep apnea patients. Sleep medicine reviews. 1997;1(1).
Grote L, Hedner J, et al. Therapy with nCPAP: Incomplete elimination of sleep related breathing disorder. European Respiratory Journal. 2000;16(5).
Mokhlesi B, Ayas NT. Cardiovascular Events in Obstructive Sleep Apnea — Can CPAP Therapy SAVE Lives? New England Journal of Medicine. 2016;375(10).
Ravesloot MJL, de Vries N, et al. Treatment adherence should be taken into account when reporting treatment outcomes in obstructive sleep apnea. The Laryngoscope. 2014;124(1).
Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society. 2008;5(2).
Eckert DJ, Malhotra A, et al. Mechanisms of Apnea. Progress in Cardiovascular Diseases. 2009;51(4).
Amatoury J, Kairaitis K, et al. Onset of airflow limitation in a collapsible tube model: impact of surrounding pressure, longitudinal strain, and wall folding geometry. Journal of applied physiology (Bethesda, Md: 1985). 2010;109(5).
Pevernagie DA, de Meyer MM, et al. Sleep, breathing and the nose. Sleep Medicine Reviews. 2005;9(6).
Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: An update. European Archives of Oto-Rhino-Laryngology. 2011;268(9).
Fitzpatrick MF, McLean H, et al. Effect of nasal or oral breathing route on upper airway resistance during sleep. European Respiratory Journal. 2003;22(5).
Kim EJ, Choi JH, et al. The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis. European Archives of Otorhinolaryngology. 2011;268(4).
Lee SH, Choi JH, et al. How does open-mouth breathing influence upper airway anatomy? The Laryngoscope. 2007;117(6).
Ishii L, Roxbury C, et al. Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis. Otolaryngology-Head and Neck Surgery. 2015;153(3).
Zeng B, Ng AT, et al. Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea. Sleep. 2008;31(4).
Park CY, Hong JH, et al. Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome. PLoS ONE. 2014;9(6).
Sundaram S, Lim J LT. Surgery for obstructive sleep apnoea/hypopnoea syndrome. Cochrane. 2013;(2).
Verse T, Dreher A, et al. ENT-specific therapy of obstructive sleep apnoea in adults: A revised version of the previously published German S2e guideline. Sleep and Breathing. 2016;20(4).
Friedman M, Ibrahim H, et al. Clinical staging for sleep-disordered breathing. Otolaryngology—head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2002;127(1).
Friedman M, Tanyeri H, et al. Clinical predictors of obstructive sleep apnea. The Laryngoscope. 1999;109(12).
Friedman M, Salapatas AM, et al. Updated Friedman Staging System for Obstructive Sleep Apnea. Advances in Oto-Rhino-Laryngology. 2017;80.
Smith MM, Peterson E, et al. The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea. Otolaryngology - Head and Neck Surgery (United States). 2017;157(2).
Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. The Laryngoscope. 2003;113(11).
Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: A new technique for the treatment of obstructive sleep apnea. 2007.
Pang KP, Pang EB, et al. Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis. European Archives of Oto-Rhino-Laryngology. 2016;273.
Soares D, Sinawe H, et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope. 2012;122(2).
Torre C, Camacho M, et al. Epiglottis collapse in adult obstructive sleep apnea: A systematic review. Laryngoscope. 2016;126(2).
Murphey AW, Kandl JA, et al. The Effect of Glossectomy for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2015;153(3).
Vicini C, Montevecchi F, et al. Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique. World Journal of Otorhinolaryngology - Head and Neck Surgery. 2017;3(2).
Vicini C, Montevecchi F, et al. Clinical outcomes and complications associated with TORS for OSAHS: A benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. Orl. 2014;76(2).
Vicini C, Montevecchi F, et al. Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: Expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty. 2014.
Miller SC, Nguyen SA, et al. Transoral robotic base of tongue reduction for obstructive sleep apnea: A systematic review and meta-analysis. The Laryngoscope. 2016.
Rabelo W, Ku DS, et al. Polysomnographic Evaluation of Propofol-Induced Sleep in Patients with Respiratory Sleep Disorders and Controls. 2013.
Hoshino Y, Ayuse T, et al. The compensatory responses to upper airway obstruction in normal subjects under propofol anesthesia. Respiratory Physiology and Neurobiology. 2009;166(1).
Hohenhorst W, Ravesloot MJL, et al. Drug-induced sleep endoscopy in adults with sleep-disordered breathing: Technique and the VOTE Classification system. Operative Techniques in Otolaryngology - Head and Neck Surgery. 2012;23(1).
Certal VF, Pratas R, et al. Awake examination versus DISE for surgical decision making in patients with OSA: A systematic review. Laryngoscope. 2016;126.
Green KK, Kent DT, et al. Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study. Laryngoscope. 2019;129(3).
Sorrenti G, Piccin O. Functional Expansion Pharyngoplasty in the Treatment of Obstructive Sleep Apnea. 2013.
Liu SY-C, Huon L-K, et al. Lateral Pharyngeal Wall Tension After Maxillomandibular Advancement for Obstructive Sleep Apnea is a Marker for Surgical Success: Observations From Drug-Induced Sleep Endoscopy. Journal of Oral and Maxillofacial Surgery. 2015.
Ong AA, Murphey AW, et al. Efficacy of Upper Airway Stimulation on Collapse Patterns Observed during Drug-Induced Sedation Endoscopy. Otolaryngology - Head and Neck Surgery (United States). 2016;154(5).
Meraj TS, Muenz DG, et al. Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea? Laryngoscope. 2017;127(4).
Eckert DJ, White DP, et al. Defining phenotypic causes of obstructive sleep apnea: Identification of novel therapeutic targets. American Journal of Respiratory and Critical Care Medicine. 2013;188(8).
D CVM. TORS for OSHAS: HOW TO IMPROVE the OUTCOMES. 2014.
Patil SP, Schneider H, et al. Neuromechanical control of upper airway patency during sleep. Journal of applied physiology (Bethesda, Md: 1985). 2007;102(2).
Schwartz AR, Smith PL, et al. Electrical stimulation of the hypoglossal nerve: a potential therapy. J Appl Physiol. 2013;1.
Strollo PJ, Soose RJ, et al. Upper-Airway Stimulation for Obstructive Sleep Apnea. New England Journal of Medicine. 2014;370(2).
Woodson BT, Soose RJ, et al. Three-Year Outcomes of Cranial Nerve Stimulation for Obstructive Sleep Apnea: The STAR Trial. Otolaryngology – Head and Neck Surgery. 2016;154(1).
Certal VF, Zaghi S, et al. Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: A systematic review and meta-analysis. The Laryngoscope. 2015;125(5).
Kezirian EJ, Hohenhorst W, et al. Drug-induced sleep endoscopy: The VOTE classification. European Archives of Oto-Rhino-Laryngology. 2011;268(8).
Neelapu BC, Kharbanda OP, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Medicine Reviews. 2017;31.
Newman AB, Foster G, et al. Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Archives of internal medicine. 2005;165(20).
Peppard PE, Young T, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA: the journal of the American Medical Association. 2000;284(23).
Magee L, Hale L. Longitudinal associations between sleep duration and subsequent weight gain: A systematic review. Sleep Medicine Reviews. 2012;16(3).
Chirinos JA, Gurubhagavatula I, et al. CPAP, Weight Loss, or Both for Obstructive Sleep Apnea. New England Journal of Medicine. 2014;370(24).
Vale F, Albergaria M, et al. Efficacy of Rapid Maxillary Expansion in the Treatment of Obstructive Sleep Apnea Syndrome: A Systematic Review With Meta-analysis. Journal of Evidence Based Dental Practice. 2017;17(3).
Camacho M, Liu SY, et al. Large maxillomandibular advancements for obstructive sleep apnea: An operative technique evolved over 30 years. Journal of Cranio-Maxillofacial Surgery. 2015;43(7).
Jordan AS, Whit DP, et al. Airway dilator muscle activity and lung volume during stable breathing in obstructive sleep apnea. Sleep. 2009;32(3).
Saboisky JP, Butler JE, et al. Functional role of neural injury in obstructive sleep apnea. Frontiers in Neurology. 2012.
Eckert DJ, Malhotra A, et al. The influence of obstructive sleep apnea and gender on genioglossus activity during rapid eye movement sleep. Chest. 2009;135(4).
Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep Medicine Reviews. 2010;14(5).
Schwartz AR. Hypoglossal nerve stimulation—Optimizing its therapeutic potential in obstructive sleep apnea. Journal of the Neurological Sciences. 2014;346(1–2).
Schwartz a R, Bennett ML, et al. Therapeutic electrical stimulation of the hypoglossal nerve in obstructive sleep apnea. Archives of otolaryngology—head & neck surgery. 2001;127.
Kezirian EJ, Goding GS, et al. Hypoglossal nerve stimulation improves obstructive sleep apnea: 12-month outcomes. Journal of Sleep Research. 2014;23(1).
Friedman M, Jacobowitz O, et al. Targeted hypoglossal nerve stimulation for the treatment of obstructive sleep apnea: Six-month results. Laryngoscope. 2016;126(11).
Sarkhosh K, Switzer NJ, et al. The impact of bariatric surgery on obstructive sleep apnea: A systematic review. Obesity Surgery. 2013;23.