PRACTICE PARAMETERS FOR THE TREATMENT OF OBSTRUCTIVE SLEEP-APNEA IN ADULTS - THE EFFICACY OF SURGICAL MODIFICATIONS OF THE UPPER AIRWAY

These clinical guidelines, which have been reviewed and approved by th e Board of Directors of the American Sleep Disorders Association, prov ide recommendations for the practice of sleep medicine in North Americ a regarding the role of surgical procedures in the treatment of obstru ctive sleep apnea in adults. Surgical procedures that are considered i nclude: uvulopalatopharyngoplasty, laser midline glossectomy and lingu alplasty, inferior sagittal mandibular osteotomy and genioglossal adva ncement with hyoid myotomy and suspension, maxillomandibular osteotomy and advancement, and tracheotomy. Whenever possible, conclusions are based on evidence from review of the literature. In instances where sc ientific data are absent, insufficient or inconclusive, recommendation s are based on consensus of opinion. The Standards of Practice Committ ee of the American Sleep Disorders Association appointed a task force to review the topic, the surgical treatment of obstructive sleep apnea . Based on the review and consultation with specialists, the subsequen t recommendations were developed by the Standards of Practice Committe e and approved by the Board of Directors of the American Sleep Disorde rs Association. Recommendations are as follows: The presence and sever ity of obstructive sleep apnea must be determined before initiating su rgical therapy. The desired treatment outcomes include resolution of t he clinical signs and symptoms of obstructive sleep apnea and the norm alization of the apnea-hypopnea index and oxyhemoglobin saturation lev els. Because of the complexity of airway narrowing or collapse during sleep, any one surgical procedure may not eradicate a patient's sleep apnea. A stepwise approach to surgical management is acceptable if the patient is advised at the onset of treatment about the likelihood of the success of each procedure and that multiple operations may be nece ssary. After the surgical site has healed, a follow-up evaluation, inc luding an objective measure of respiration and quality of sleep, must be performed to ensure that the abnormalities noted in the original st udy are corrected.