| Autor: |
De Vito A; Ear Nose Throat (ENT) Unit, Head & Neck Department, Santa Maria delle Croci Hospital, Romagna Health Service, 48121 Ravenna, Italy., Woodson BT; Division of Sleep Medicine and Upper Airway Reconstructive Surgery, Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI 53226, USA., Koka V; Department of Sleep Medicine, Hospital Antoine Beclere, 92140 Clamart, France., Cammaroto G; Ear Nose Throat (ENT) Unit, Head & Neck Department, Morgagni-Pierantoni Hospital, Romagna Health Service, 47121 Forlì, Italy., Iannella G; Ear Nose Throat (ENT) Unit, Head & Neck Department, Morgagni-Pierantoni Hospital, Romagna Health Service, 47121 Forlì, Italy., Bosi M; Private Hospitals Group, 47121 Forlì, Italy., Pelucchi S; Clinic of Otorhinolaryngology, Neuroscience and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy., Filograna-Pignatelli GR; Ear Nose Throat (ENT) Unit, Head & Neck Department, Santa Maria delle Croci Hospital, Romagna Health Service, 48121 Ravenna, Italy., El Chater P; ENT Department, Sulaiman, Al Habib Hospital, Dubai Health Care City, 505005 Dubai, United Arab Emirates., Vicini C; Ear Nose Throat (ENT) Unit, Head & Neck Department, Morgagni-Pierantoni Hospital, Romagna Health Service, 47121 Forlì, Italy. |
| Abstrakt: |
Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients' in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes. |
