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.
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