Managing Complete Concentric Collapse in Obstructive Sleep Apnea: A Narrative Review

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by intermittent airway obstruction during sleep, often leading to significant cardiovascular and metabolic consequences. One particularly challenging type of OSA involves complete concentric collapse (CCC) of the upper airway, which complicates management by limiting the effectiveness of conventional therapies such as continuous positive airway pressure (CPAP) and hypoglossal nerve stimulation (HGNS). This narrative review examines current surgical treatments for OSA, including uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP), maxillomandibular advancement (MMA), and other skeletal surgeries, with a focus on the challenges of treating patients with CCC. We discuss the limitations of HGNS in this population and critically review studies that have contraindicated HGNS due to airway dynamics, highlighting the small patient populations and limited generalizability. Finally, we explore the potential of bilateral HGNS (B-HGNS) as a promising alternative, which may synchronize the activation of both genioglossus muscles and improve airway stability. This review emphasizes the need for further research on B-HGNS and the development of treatment strategies that reduce reliance on invasive surgeries and optimize outcomes for patients with CCC.