Minimally Invasive Surgical Treatments for Obstructive Sleep Apnea
Surgery remains an option for patients who cannot tolerate positive airway pressure treatment but carries risks that must be considered.
Reshaping of the epiglottis using a CO2 laser has been studied with cadaver specimens. The researchers believe scar formation following the reshaping would aid in retraction of the epiglottis anteriorly. Studies with animals are being conducted with different laser types. Future studies involving selected patients with OSA who have epiglottis malformations would be the next step.27
More studies about both minimally invasive and invasive surgeries for OSA are needed. There are many unanswered questions, including the timing of follow-up assessments, how long to observe a patient after surgery, whether the use of multilevel surgery affects the rate of relapse, and what are the best follow-up tools to use. Research needs to be performed in diverse populations, including gender, race/ethnicity, and age groups. Complications of surgical procedures need to be studied and clarified over both short- and long-term periods.9
Conclusions
Although there have been some successes in using surgical procedures to treat OSA, CPAP therapy remains the first-line treatment. Invasive surgeries have higher rates of complications and risks than do those of minimally invasive procedures. There are also additional risks related to the use of anesthesia both during and after surgery. Referrals for surgery should include information about a diagnosis of OSA, and patients should be instructed to discuss this with the anesthesiologist or certified nurse anesthetist.
With careful selection by the surgeon and sleep providers, patients who do not tolerate CPAP therapy or respond to other noninvasive interventions can benefit from a surgical procedure. Minimally invasive surgeries are less risky for the patient and should be considered.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
WEB EXCLUSIVE CASE STUDY
A Physical Examination of the Upper Airway by an Ear, Nose, and Throat Physician
