Surgical treatment in obstructive sleep apnea syndrome: an overview

Authors

  • Lucrezia Sparacino ENT, Audiology and Phoniatrics Unit, University Hospital, Pisa, Italy http://orcid.org/0000-0002-0277-9762
  • Luca Bruschini ENT, Audiology and Phoniatrics Unit, University Hospital, Pisa, Italy
  • Andrea De Vito ENT, Audiology and Phoniatrics Unit, University Hospital, Pisa, Italy
  • Giacomo Fiacchini ENT, Audiology and Phoniatrics Unit, University Hospital, Pisa, Italy
  • Stefano Berrettini ENT, Audiology and Phoniatrics Unit, University Hospital, Pisa, Italy; Division of ENT Diseases, Karolinska Institutet, Stockholm, Sweden

DOI:

https://doi.org/10.18203/2349-2902.isj20203284

Keywords:

Obstructive sleep apnea syndrome, OSAS, Surgery

Abstract

Obstructive sleep apnea syndrome is a common pathology affecting pediatric and adult population. It is caused by an increase upper airway resistance due to augmented collapsibility that cause alteration in ventilation and oxygen saturation. Sleep oxygen desaturations have multi-organ implications. Since many years, OSAS, has been recognized as a risk factors for comorbid cardiovascular disease. Well-known is the causal link with cognitive impairment and atherosclerosis. Healthcare professionals, should be trained to recognize signs and symptoms of the disease in order to send the patients forward for specialist care in centers dealing with sleep-disordered breathing. However treatment knowledge is of pivotal importance in the cultural baggage of all the physicians.  Surgical and non-surgical therapies have undergone a great number of changes. Going along with the innovations in diagnostic evaluation and phenotyping of the patients, surgeries were heightened by new developments such as advances in tailoring procedures and technologies. The aim of this overview is to describe the evolution and main characteristics of encoded procedures classified into site of surgical correction.

Author Biography

Lucrezia Sparacino, ENT, Audiology and Phoniatrics Unit, University Hospital, Pisa, Italy

Research fellow in Otolaryngology Audiology and phoniatrics department (AOUP)

 

References

Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea. J Clin Sleep Med. 2009;5:263-76.

Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504.

Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscipl Respir Med. 2019;14:8.

Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862-5.

Sutherland K, Kairaitis K, Yee BJ, Cistulli PA. From CPAP to tailored therapy for obstructive sleep Apnoea, Sutherland et al. Multidiscipl Respir Med. 2018;13:44.

Hall M. The instrument for tracheotomy. Lancet. 1848;2:530.

Kuhl W, Doll E, Franck MC. Successful management of Pickwickian syndrome using long-term tracheostomy. Dtsch Med Wochenschr. 1969;94(24):1286-90.

Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci. 1991;16(5):504-9.

Meyer W. On adenoid vegetations in the nasopharyngeal cavity, their pathology, diagnosis and treatment. Hospitalstidende Copenhagen. 1868;11:177-8.

Betz F. On the snoring of very young children. Memorabilia Heilbronn. 1858;3:73-7.

De Vito A, Berrettini S, Carabelli A, Sellari-Franceschini S, Bonanni E, Gori S, et al. The importance of nasal resistance in obstructive sleep apnea syndrome: a study with positional rhinomanometry. Sleep Breath. 2001;5(1):3-11.

Cai Y, Goldberg AN, Chang JL. The nose and nasal breathing in sleep apnea. Otolaryngol Clin North Am. 2020;53(3):385-95.

Vicini C, De Vito A, Benazzo M, Frassineti S, Campanini A, Frasconi P, et al. The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol. 2012;269(4):1297-300.

Ikematsu T. Study of snoring: therapy. J Japan Otol Rhinol Laryngol Soc. 1964;64:434-5.

Quesada P, Botet J, Fuentes E, Perelló E. Partial resection of the soft palate as treatment for hypersomnia and breathing syndrome in obese patients. ORL Dips. 1977;5:81-8.

Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981;89(6):923-34.

Ellis PD. Laser palatoplasty for snoring due to palatal flutter: a further report. Clin Otolaryngol Allied Sci. 1994;19(4):350-1.

Pang KP, Terris DJ. Modified cautery-assisted palatal stiffening operation: new method for treating snoring and mild obstructive sleep apnea. Otolaryngol Head Neck Surg. 2007;136(5):823-6.

Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope. 2003;113(11):1961-8.

Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2007;137(1):110-4.

Pang KP, Piccin O, Pang EB, Pang KA, Chan YH, Rotenberg BW. Combined expansion pharyngoplasty and anterior palatoplasty for the treatment of OSA. Indian J Otolaryngol Head Neck Surg. 2016;68(4):528-533.

Mantovani M, Minetti A, Torretta S, Pincherle A, Tassone G, Pignataro L. The velo-uvulo-pharyngeal lift or “roman blinds” technique for treatment of snoring: a preliminary report. Acta Otorhinolaryngologica Italica. 2012;32:48-53.

Salamanca F, Costantini F, Mantovani M, Bianchi A, Amaina T, Colombo E, et al. Barbed anterior pharyngoplasty: an evolution of anterior palatoplasty. Acta Otorhinolaryngologica Italica. 2014;34:434-8.

Vicini C, Hendawy E, Campanini A, Eesa M, Bahgat A, AlGhamdi S, et al. Barbed reposition pharyngoplasty (BRP) for OSAHS: a feasibility, safety, efficacy and teachability pilot study. ‘‘We are on the giant’s shoulders’’. Eur Arch Otorhinolaryngol. 2015;272(10):3065-70.

Mantovani M, Carioli D, Torretta S, Rinaldi V, Ibba T, Pignataro L. Barbed snore surgery for concentric at the velum collapse: the Alianza technique. J Cranio-Maxillofac Surg. 2017;45(11):1794-800.

Djupesland G, Schrader H, Lyberg T, Refsum H, Lilleås F, Godtlibsen OB. Palatopharyngoglossoplasty in the treatment of patients with obstructive sleep apnea syndrome. Acta Otolaryngol Suppl. 1992;492(492):50-4.

Kaya N. Sectioning the hyoid bone as a therapeutic approach for obstructive sleep apnea. Sleep. 1984;7(1):77-8.

Chabolle F, Wagner I, Blumen MB, Séquert C, Fleury B, De Dieuleveult T. Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea. Laryngoscope. 1999;109(8):1273-80.

Powell NB, Riley RW, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: A pilot study. Otolaryngol Head Neck Surg. 1999;120(5):656-64.

Vicini C, Dallan I, Canzi P, Frassineti S, La Pietra MG, Montevecchi F. Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: a preliminary report. ORL 2010;72:22-7.

Vicini C, Montevecchi F, Pang K, Bahgat A, Dallan I, Frassineti S, et al. Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea-hypopnea syndrome: Expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty. Head Neck. 2013;36:77-83.

Andersen APD, Alving J, Lildholdt T, Wulff CH. Obstructive sleep apnea initiated by a lax epiglottis. A contraindication for continuous positive airway pressure. Chest. 1987;91(4):621-3.

Fearon B, Ellis D. The management of long term airway problems in infants and children. Ann Otol Rhinol Laryngol. 1971;80(5):669-77.

Lane RW, Weider DJ, Steinem C, Marin-Padilla M. Laryngomalacia. A review and case report of surgical treatment with resolution of pectus excavatum. Arch Otolaryngol. 1984;110(8):546-51.

Salamanca F, Leone F, Bianchi A, Bellotto R, Costantini F, Salvatori P. Surgical treatment of epiglottis collapse in obstructive sleep apnoea syndrome: epiglottis stiffening operation, Acta Otorhinolaryngologica Italica. 2019;39:404-8.

Browaldh N, Markstrom A, Friberg D. Elective tracheostomy is an alternative treatment in patients with severe obstructive sleep apnoea syndrome and CPAP failure. Acta Oto-Laryngologica. 2009;129:1121-6.

Costantino A, Rinaldi V, Moffa A, Luccarelli V, Bressi F, Cassano M, et al. Hypoglossal nerve stimulation long-term clinical outcomes: a systematic review and meta-analysis. Sleep Breath. 2019:1-3.

Strollo PJ, Soose RJ, Maurer JT, Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370:139-49.

Ohen-Levy J, Petelle B, Vieille E, Dumitrache M, Fleury B. Changes in facial profile after maxillomandibular advancement surgery for obstructive sleep apnea syndrome. Int Orthodont. 2013;11:71-92.

Zaghi S, Holty JE, Certal V, Abdullatif J, Guilleminault C, Powell NB, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Head Neck Surg. 2016;142(1):58-66.

Downloads

Published

2020-07-23

Issue

Section

Review Articles