The Journal of the Korean dental association (대한치과의사협회지)

The Korean Dental Association (대한치과의사협회)
권호 표지

Surgical approach for treatment of obstructive sleep apnea

폐쇄성 수면무호흡증(Obstructive Sleep Apnea)의 외과적 처치

  • Kim, Tae-Kyung (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University) ;
  • Lee, Deok-Won (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University)
  • 김태경 (강동경희대학교치과병원 구강악안면외과) ;
  • 이덕원 (강동경희대학교치과병원 구강악안면외과)
  • Received : 2015.07.14
  • Accepted : 2015.10.15
  • Published : 2015.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Obstructive sleep apnea (OSA), most common respiratory disorder of sleep, is characterized by intermittent partial or complete occlusions of the upper airway due to loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxemia, which leads to poor quality of sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Untreated OSA may cause, or be associated with, several adverse outcomes, including daytime sleepiness, increased risk for motor vehicle accidents, cardiovascular disease, and depression. Various treatments are available, including non-surgical treatment such as medication or modification of life style, continuous positive airway pressure (CPAP) and oral appliance (OA). Skeletal surgery for obstructive sleep apnea (OSA) aims to provide more space for the soft tissue in the oropharynx to prevent airway collapse during sleep. Conventional surgical techniques include uvopalatopharyngoplasty(UPPP), genioglossus advancement (GA), and maxillomandibular advancement (MMA). Surgical techniques, efficacy and complications of skeletal surgery are introduced in this review.

Keywords

Acknowledgement

Supported by : Small and Medium Business Administration(SMBA)

References

  1. Kim J, In K, Kim J, You S, Kang K, Shim J, Lee S, Lee J, Lee S, Park C, Shin C. Prevalence of sleepdisordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med 2004;170:1108-1113. https://doi.org/10.1164/rccm.200404-519OC
  2. Malhotra, White DP. Obstructive sleep apnoea. Lancet 2002;360:237-245 https://doi.org/10.1016/S0140-6736(02)09464-3
  3. Engleman HM, Douglas NJ. Sleep. Sleepiness, cognitive function, and quality of life in obstructive sleep apnonea/hypopnoea syndrome. Thorax. 2004;59:618-622. https://doi.org/10.1136/thx.2003.015867
  4. Robinson GV, Stradling JR, Davies RJO. Sleep. Obstructive sleep apnea/hypopnea syndrome and hypertension. Thorax 2004;59:1089-1094. https://doi.org/10.1136/thx.2003.015875
  5. Marin JM, Carrizo SJ, Vicente E, Agusti AG, Longterm cardiovascular outcomes in men with obstructive sleep apnoeahypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53. https://doi.org/10.1016/S0140-6736(05)74229-X
  6. Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI.Obstructive sleep apnea and cardiovascular disease: Role of the metabolic syndrome and its components. J Clin Sleep Med 2008;15:4(3):261-72.)
  7. Blakley BW, Mahowald MW, Nasal resistance and sleep apnea. Laryngoscope 1987?;97:752-754
  8. Piche J. Gagnon NB. Snoring, apnea, and nasal resistance, J Otolaryngol 1996;25:150-154
  9. Schwab RJ, Kuna ST, Remmers JE. Anatomy and physiology of upper airway obstruction. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Elesevier Saunders, 2005:983-1000.
  10. Koo SK, Choi JW, Myung NS, Lee HJ, Kim YJ, Kim YJ. Analysis of obstruction site in obstructive sleep apnea syndrome patients by drug induced sleep endoscopy. Am J Otolaryngol 2013;34:626-630. https://doi.org/10.1016/j.amjoto.2013.07.013
  11. Fujita S, Conway WA, Zorick FJ, et al. Evaluation of the effectiveness of uvulopalatopharyngoplasty. Laryngoscope 1985;95:70-74
  12. Kamami YV. Outpatient treatment of snoring with CO2 laser: laser-assited UPPP. J Otolaryngol 1994;23:395-398
  13. Zohar Y, Finkelstein Y, Strauss M, et al. Surgical treatment of obstructive sleep apnea: technical variation. Arch Otolaryngol Head Neck Surg 1993;119:1023-1029 https://doi.org/10.1001/archotol.1993.01880210113016
  14. Schechtman KB, Piccirillo JF, Sher AF. Methodological and statistical problems in sleep apnea research: the literature on uvuloplaltopharyngolplasty. Sleep 1996;18:659-666
  15. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156-177 https://doi.org/10.1093/sleep/19.2.156
  16. Jason C, Gialason T, Bengtsson H, et al. Longterm follow-up of patients with obstructive sleep apnea treated with uvulopalatophtyngoplasty. Arch Otolaryngol Head Neck Surg 1997;123:257-262 https://doi.org/10.1001/archotol.1997.01900030025003
  17. Goh YH, Mark I, Fee WE Jr. Quality of life 17 to 20 years after uvulopalatopharyngoplasty. Laryngoscope 2007;117:503-506. https://doi.org/10.1097/MLG.0b013e31802d83bd
  18. Aurora RN, Casey KR, Kristo D, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010;33:1408-1413. https://doi.org/10.1093/sleep/33.10.1408
  19. Weitsman ED, Kahn E, Pollack CP. Quantitative analysis of sleep and sleep apnea before and after tracheostomy in patients with the hypersomnia sleep apnea syndrome. Sleep 1980;3:407-423 https://doi.org/10.1093/sleep/3.3-4.407
  20. Kiran S, Eapen S, Chopra V. A comparative study of complications and long term outcomes of Surgical Tracheostomy and two techniques of Percutaneous Tracheostomy. Indian J Crit Care Med 2015;19:82-86. https://doi.org/10.4103/0972-5229.151015
  21. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg 1994;111:717-721 https://doi.org/10.1016/S0194-5998(94)70557-7
  22. Verse T, Baisch A, Hormann K, Muli-level surgery for obstructive sleep apnea. Preliminary objective results. Laryngohinootologie 2004;83:516-522 https://doi.org/10.1055/s-2004-814553
  23. Li KK, Guilleminault C, Riley RW, Powell NB. Obstructive sleep apnea and maxillomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinations. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2002;60:526-30; discussion 31. https://doi.org/10.1053/joms.2002.31849
  24. Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Long-Term Results of Maxillomandibular Advancement Surgery. Sleep & breathing = Schlaf & Atmung 2000;4:137-40. https://doi.org/10.1055/s-2000-11564
  25. Riley R, Guilleminault C, Powell N, Derman S. Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea: a case report. Sleep 1984;7:79-82. https://doi.org/10.1093/sleep/7.1.79
  26. Li KK, Powell NB, Riley RW, Troell R, Guilleminault C. Overview of phase I surgery for obstructive sleep apnea syndrome. Ear, nose, & throat journal 1999;78:836-7, 41-5.
  27. Silverstein K, Costello BJ ,Giannakpoulos H, et al. Genioglossusmuscle attachments: an anatomic analysis and the implications for genioglossus advancement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:686-8. https://doi.org/10.1067/moe.2000.111187
  28. Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2009;5:263-76.
  29. Kim J, In K, Kim J, et al. Prevalence of sleepdisordered breathing in middle-aged Korean men and women. American journal of respiratory and critical care medicine 2004;170:1108-13. https://doi.org/10.1164/rccm.200404-519OC