Surgical and Non-Surgical Management of Sleep Disorders
Non-surgical options
Positive airway pressure is first-line for moderate-severe OSA. Mandibular advancement devices suit mild-moderate OSA or PAP intolerance. Weight loss, positional therapy, and myofunctional therapy are adjuncts. Hypoglossal nerve stimulation is an option for selected PAP-intolerant patients meeting criteria (BMI limits, absent complete concentric collapse on drug-induced sleep endoscopy).
Surgical options
Adenotonsillectomy is first-line in children. In adults, uvulopalatopharyngoplasty, maxillomandibular advancement, and other procedures are selected based on anatomy and drug-induced sleep endoscopy findings. Tracheostomy is reserved for severe refractory cases. Bariatric surgery improves OSA with weight loss.
Traps
- Surgery is not first-line for unselected adult OSA; patient selection matters.
- UPPP alone has variable success; anatomic evaluation guides choice.
- Hypoglossal nerve stimulation requires absence of complete concentric palatal collapse.
- Weight loss may not cure OSA; reassess after significant loss.
Rule of thumb
Match therapy to anatomy and adherence: PAP first, then MAD or surgery for intolerance, with DISE guiding surgical selection.