Upper airway surgery in obstructive sleep apnoea

Surgical treatment of obstructive sleep apnoea (OSA) is mainly aimed at enlarging the upper airway and making it less susceptible to collapse during sleep in patients who do not want or cannot be treated by other means. Surgical success has commonly been defined as a o50% reduction in apnoea/ hypopnoea index (AHI) associated with a post-operative AHI of <20 events*h-1. Subjective improvement ensues more often than resolution of respiratory disorders. Long-term relapse may occur. Pre-operatively, radiological and endoscopic tests may provide indications regarding the site of upper airway closure during sleep. Pharyngeal, hyoid and lingual surgery may show effectiveness when airway occlusion occurs at specific sites; their degree of success ranges 60-70%. In adults, radiofrequency volume reduction of the tongue and/or the soft palate is convenient for subjects with mild OSA. Maxillomandibular advancement and tracheostomy are almost always effective, irrespective of the site of obstruction and the severity ofOSA. In children, adenotonsillectomy and maxillary distraction osteogenesis are often followed by favourable outcomes, at least in non-obese subjects.