Surgical alternatives for treatment of obstructive sleep apnoea: review and case series

Obstructive sleep apnoea (OSA) affects up to 24% of middle aged males, resulting in excessive daytime sleepiness, cognitive dysfunction, hypertension, increased risks for acute coronary events, stroke and auto accidents. At special risk are individuals with BMI greater than 29, neck circumference greater than 43 cm (17 inches), macroglossia and retrognathia. Although non-surgical nasal positive air pressure (nCPAP) and mandibular advancement oral appliances are often effective and are the most widely used therapy, they are not definitive for more severe OSA and patients show poor long-term compliance. Surgical reduction of palatal, lingual and nasal soft tissue volumes improve airway functions in approximately 40% of patients with mild to moderate OSA. Maxillary and mandibular advancement osteotomies have proven over the past decade to reverse even severe OSA at greater than the 90% efficacy levels. Surgical treatment targeted to skeletal and airway soft tissue anomalies using a multidisciplinary treatment approach can have a major impact on this widespread and high-risk disorder.