A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.

Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis

Outcome measurement in sleep medicine practice and research. Part 1: assessment of symptoms, subjective and objective daytime sleepiness, health-related quality of life and functional status

Modified uvulopalatopharyngoplasty: The extended uvulopalatal flap.

Pharyngeal size, compliance, and the dynamic behavior of the upper airway are important factors in the production of obstructive sleep apnea. Assessment of the upper airway for possible site(s) of ...

Normal Standard Curve for Acoustic Pharyngometry

Primary and secondary telegnathic maxillomandibular advancement, with or without adjunctive procedures, for obstructive sleep apnea in adults: a literature review and treatment recommendations.

In this paper we describe the outcome of a prospective study designed to investigate the role of uvulopalatopharyngoplasty in the management of mild obstructive sleep apnoea. A group of 21 patients fulfilling strict inclusion and exclusion criteria underwent uvulopalatopharyngoplasty performed by a single surgeon using a modified technique. Specifically designed daily pain questionnaires were completed by the patients for 2 weeks after surgery and the morbidity associated with the procedure was assessed at 2, 6 and 12 weeks after operation. Thirteen of the 21 patients underwent a postoperative sleep study at 3 months after operation. The outcome measures used were the apnoea/hypopnoea index, the minimum O2 saturation, the sleep arousal index, the sleep architecture, the Epworth Sleepiness Scale score, the subjective improvement in both the patient's and their partner's sleep and the morbidity associated with uvulopalatopharyngoplasty. We conclude that the patients with mild obstructive sleep apnoea most likely to obtain significant benefit from uvulopalatopharyngoplasty are those with a body mass index of between 27 and 30 with no cephalometric disproportion, those with frequent arousals not associated with periodic limb movements, those whose sleep related breathing disorder is not positional and most importantly those with symptomatic day time sleepiness.

A three‐centre prospective pilot study to elucidate the effect of uvulopalatopharyngoplasty on patients with mild obstructive sleep apnoea due to velopharyngeal obstruction

Croft

Papers

A three‐centre prospective pilot study to elucidate the effect of uvulopalatopharyngoplasty on patients with mild obstructive sleep apnoea due to velopharyngeal obstruction