Treatment Options - Surgery
The following surgical treatment options for OSA may be considered
- Uvulopalatopharyngoplasty (UPPP)
- Lateral pharyngoplasty
- Expansion sphincter pharyngoplasty
- Reposition pharyngoplasty
- Tongue volume reducing surgery (Transoral robotic surgery (TORS)
- Coblation endoscopic lingual lightening (CELL)
- Submucosal minimally invasive lingual excision (SMILE)
- Tongue bone position-changing surgery (hyoid thyroidpexia)
- Stiffening procedures with radiofrequency thermotherapy of the tongue base (RFTB) or the palatum
- Maxillomandibular Advancement surgery (MMA)
If the patient
- Has a significant craniofacial abnormality
- Is a thin snorer
- Has mild OSA with upper airway crowding
- Has severe OSA which cannot be treated with continuous positive airway pressure (CPAP, due to refusal or intolerance) and/or mandibular advancement splint (MAS)
In Australia, hypoglossal nerve simulation is used in the research setting only to date. The technique involves implantation of a nerve stimulator over the hypoglossal nerve to stimulate tongue muscles during sleep to stabilise the upper airway.
A sleep physician can provide advice on which patients should be referred for surgical treatment options for OSA.
AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset