Obstructive sleep apnea (OSA) is known to be associated with metabolic syndrome, diabetes, hypertension which predispose to cardiovascular disease. Hypoxia due to OSA can predispose an individual to development of endothelial dysfunction. Additionally, imbalance between sympathetic–parasympathetic activity can initiate arrhythmias and result in sudden cardiac death. If OSA is diagnosed early and appropriately treated, we can prevent morbidity and mortality in patients with cardiac disease who also have OSA.

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by repetitive collapse of the upper airways leading to intermittent hypoxia and sleep disruption. Clinically relevant neurocognitive, metabolic and cardiovascular disease often occurs in OSA. Systemic hypertension, coronary artery disease, type 2 diabetes mellitus, cerebral vascular infarctions and atrial fibrillation are among the most often cited conditions with causal connections to OSA. Emerging science suggests that untreated and undertreated OSAs increase the risk of developing cognitive impairment, including vascular dementia and neurodegenerative disorders like Alzheimer's disease. As with OSA, cardiovascular disease and type 2 diabetes mellitus, the incidence of dementia increases with age. Given our rapidly aging population, dementia prevalence will significantly increase. The aim of this treatise is to review current literature linking OSA to dementia and explore putative mechanisms by which OSA might facilitate the development and progression of dementia.

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.

Introduction: Surgery for obstructive sleep apnea (OSA) has evolved significantly over the last few decades owing to lessons learned from prior failures and increased understanding of this condition. Analysis of single-level palatal surgery failures and the advent of sleep endoscopy showed the presence of a concomitant hypopharyngeal obstruction, highlighting the importance of hypopharyngeal obstruction in the treatment of OSA. Objective: This article aims to delineate the concepts behind optimal patient selection for hypopharyngeal OSA surgery. Results: Understanding the various factors contributing to hypopharyngeal obstruction allows the treating surgeon to build a framework in the thought process. This allows customization in selecting proper surgical techniques for individual patients in the setting of treating this multifactorial condition. These concepts include understanding the significance of hypopharyngeal obstruction, the concept of volume reduction versus tension enhancement in upper airway surgery, synchronization of major airway dilator with respiration during sleep, the notion of multilevel surgery and significance of holistic management in OSA. It is also important to understand multiple surgeries or different types of surgery may be applicable at the different timeline, for the same patients. Optimal treatment outcome relies on accurate assessment. Assessment methods of particular relevance to hypopharyngeal surgery for OSA include drug-induced sleep endoscopy, Friedman Tongue Position and tongue base lymphoid tissue grading. Types of hypopharyngeal surgery, their indication and efficacy are also discussed in this article. Conclusion: Hypopharyngeal obstruction is prevalent, and its presence is associated with increased OSA severity. In the context of hypopharyngeal surgery for OSA, the key achieving optimal outcome is integration of targeted treatment, clinical expertise, patient preference, and understanding potential positive and negative predictive clinical findings.