Sleep surgery

The Wisconsin Sleep Cohort Study, a longitudinal study of the natural history of obstructive sleep apnea (OSA), found that of a random sample (602 employed men and women, 30–60 years old) the prevalence of OSA (5 or more events/hr) was 9% for women and 24% for men.

However, the study found that among sleepy patients in this group, 2% of women and 4% of men met criteria for obstructive sleep apnea syndrome (OSAS).

A systematic review of the literature and meta-analysis showed that multilevel sleep surgery achieves a 60.3% apnea hypopnea index (AHI) reduction.

[3] Even single level surgical intervention in sleep apnea, which demonstrates a lesser degree of AHI reduction, showed a 31% survival benefit when compared against those using CPAP as therapy.

[5] A sub-group of children may have occult laryngomalacia, where the tissue directly above the vocal cords (epiglottis, arytenoids) collapses into the airway during sleep.

There is a longer recovery when compared to other sleep apnea surgeries, since the bones of the face have to heal into their new position.

In 1981, Dr. Sullivan and colleagues introduced continuous positive airway pressure (CPAP), which replaced tracheostomy as the gold standard treatment for obstructive sleep apnea.

Where appropriate, they are considered a good therapy choice as they are non-invasive, easily reversible, quiet, and generally well accepted by the patient.

The focus of improvement in appliance design is in reducing bulk, permitting free jaw movement (i.e., yawning, speaking, and drinking), and allowing the user to breathe through their mouth (early "welded gum shield"-type devices prevented oral breathing).

Over the last decade, there has been a significant expansion in the evidence base supporting the use of oral devices in the treatment of OSA.

[11] Robust studies demonstrating their efficacy have been underpinned by increasing recognition of the importance of upper airway anatomy in the pathophysiology of OSA.

[12] Oral devices have been shown to have a beneficial effect in targeting a number of significant clinical end points.

These include the polysomnographic indexes of OSA, subjective and objective measures of sleepiness, blood pressure, aspects of neuropsychological functioning, and quality of life.