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Chapter 130 - Surgery for obstructive sleep apnea

from Section 25 - Otolaryngologic Surgery

Published online by Cambridge University Press:  05 September 2013

Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Obstructive sleep apnea (OSA) is a serious and chronic condition affecting as many as 15–20 million American adults. Resulting sleep deprivation has been linked to motor vehicle and workplace accidents. The incidence of OSA is increasing with the obesity epidemic, and it is increasingly recognized as a mediator of cardiovascular disease including atrial fibrillation, stroke, myocardial infarction, and sudden cardiac death. The importance of appropriate diagnosis and timely treatment thus cannot be overstated.

Obstructive sleep apnea manifests by repeated episodes of apnea or hypopnea during sleep. During deeper levels of sleep, especially that characterized by rapid eye movement (REM), there is loss of the normal tone of the pharyngeal and tongue muscles that keep the pharynx open, resulting in collapse of the oropharyngeal and nasopharyngeal airway. In the majority of the population this decrease in airway diameter is clinically insignificant. However, in OSA patients the varied degree of airway obstruction can have clinical consequences. Narrowing of the airway causes increased velocity of inspiratory airflow in the pharynx, causing decreased intraluminal pressure, further tissue collapse, and increased airway obstruction (Bernoulli's principle). In instances of complete airway obstruction, the patient will experience apnea, a cessation of breathing for at least 10 seconds. Incomplete obstruction may result in hypopnea, a reduction in airflow with associated oxygen desaturation, which is more common. Each apnea or hypopnea episode continues until the patient awakens to a more shallow level of sleep, which results in a recovery of pharyngeal muscle tone and recovery of airway integrity. The more frequent the apnea and hypopnea, the more fragmented the sleep, which results in greater sleep deprivation due to the lack of adequate REM activity.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 761 - 763
Publisher: Cambridge University Press
Print publication year: 2013

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References

Epstein, LJ, Kristo, D, Strollo, PJ et al. Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5: 263–76.Google ScholarPubMed
Franklin, KA, Anttila, H, Axelsson, S et al. Effects and side-effects of surgery for snoring and obstructive sleep apnea – a systematic review. Sleep 2009; 32: 27–36.Google ScholarPubMed
Fujita, S, Conway, W, Zorick, F, Roth, T.Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 1981; 89: 923–34.CrossRefGoogle Scholar
Kakkar, RK, Berry, RB.Positive airway pressure treatment for obstructive sleep apnea. Chest 2007; 132: 1057–72.CrossRefGoogle ScholarPubMed
Lin, HC, Friedman, M, Chang, HW et al. The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope 2008; 118: 902–8.CrossRefGoogle ScholarPubMed
Lopez-Jimenez, F, Sert Kuniyoshi, FH, Gami, A et al. Obstructive sleep apnea: implications for cardiac and vascular disease. Chest 2008; 133: 793–804.CrossRefGoogle ScholarPubMed
Mickelson, SA, Hakim, I.Is postoperative intensive care monitoring necessary after uvulopalatopharyngoplasty?Otolaryngol Head Neck Surg 1998; 119: 352–6.CrossRefGoogle ScholarPubMed
Riley, RW, Powell, NB, Guilleminault, C et al. Obstructive sleep apnea surgery: risk management and complications. Otolaryngol Head Neck Surg 1997; 117: 648–52.CrossRefGoogle ScholarPubMed
Riley, RW, Powell, NB, Kasey, KL et al. Surgery and obstructive sleep apnea: long-term clinical outcomes. Otolaryngol – Head Neck Surg 2000; 122: 415–21.CrossRefGoogle ScholarPubMed
Schendel, SA, Powell, NB.Surgical orthognathic management of sleep apnea. J Craniofacial Surg 2007; 18(4): 902–11.CrossRefGoogle ScholarPubMed
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: 156–77.CrossRefGoogle ScholarPubMed
Young, T, Palta, M, Dempsey, J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–5.CrossRefGoogle ScholarPubMed

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