Oral & Maxillofacial Surgery & Department of Dentistry, St Joseph's Regional Medical Center, Paterson, NJ, USA.
Indian J Med Res. 2010 Feb;131:267-76.
Obstructive sleep apnoea (OSA) syndrome is a potentially serious disorder affecting millions of people around the world. Many of these individuals are undiagnosed while those who are diagnosed, often exhibit poor compliance with nightly use of continuous positive airway pressure (CPAP), a very effective nonsurgical treatment. Various surgical procedures have been proposed to manage and, in some cases, treat OSA. In this article we review methods used to assess the sites of obstruction and a number of surgical procedures designed to address OSA. Effective surgical management of OSA depends upon developing a complete database and determining different levels of obstruction, which may include nasal, nasopharyngeal, oropharyngeal, and hypopharyngeal/retrolingual, or a combination of these sites. A systematic approach to clinical evaluation, treatment planning and surgical management is recommended and is likely to result in more predictable outcomes. Surgical treatment may involve various procedures that are performed in different stages depending on the patient's sites of obstruction. The most commonly performed procedures include nasal reconstruction, uvulopalatopharyngoplasty (UPPP), advancement genioplasty, mandibular osteotomy with genioglossus advancement, and hyoid myotomy and suspension. In more severe cases, maxillomandibular advancement (MMA) with advancement genioplasty may be indicated. Even after appropriate surgical treatment, some patients may demonstrate continued obstruction with associated symptoms. Published indications for surgical treatment include an elevated respiratory disturbance index (RDI) with excessive daytime somnolence (EDS), oxygen desaturations below 90 per cent, medical co-morbidities including hypertension and arrhythmias, anatomic abnormalities of the upper airway and failure of medical treatment. The success of surgery in OSA is generally measured by achieving a (RDI) of less than 5, improvement of oxygen nadir to 90 per cent or more with no desaturations below 90 per cent and quality of life improvements with elimination or significant reduction of OSA symptoms. From a practical point of view, achieving these goals may be extremely difficult without patients' cooperation, most notably in the realm of weight loss and maintenance of a healthy lifestyle.
阻塞性睡眠呼吸暂停（OSA）综合征是一种潜在的严重疾病，影响着全球数以百万计的人。其中许多人未被诊断出来，而那些被诊断出来的人，往往对夜间使用持续气道正压通气（CPAP）的依从性很差，CPAP 是一种非常有效的非手术治疗方法。已经提出了各种手术程序来管理和在某些情况下治疗 OSA。在本文中，我们回顾了评估阻塞部位的方法和一些旨在解决 OSA 的手术程序。OSA 的有效手术治疗取决于建立完整的数据库并确定不同程度的阻塞，这些阻塞可能包括鼻腔、鼻咽、口咽和咽后/舌后，或这些部位的组合。建议采用系统的临床评估、治疗计划和手术管理方法，这可能会导致更可预测的结果。手术治疗可能涉及各种程序，这些程序根据患者的阻塞部位在不同阶段进行。最常进行的手术包括鼻重建、悬雍垂腭咽成形术（UPPP）、颏前突成形术、下颌骨切开术和颏舌肌切开术和悬吊术。在更严重的情况下，可能需要进行上颌骨和下颌骨前突（MMA）和颏前突成形术。即使进行了适当的手术治疗，一些患者可能仍会出现持续的阻塞和相关症状。手术治疗的适应证包括呼吸紊乱指数（RDI）升高伴有白天过度嗜睡（EDS）、氧饱和度低于 90%、高血压和心律失常等合并症、上呼吸道解剖异常以及药物治疗失败。OSA 手术的成功通常通过实现（RDI）小于 5、氧最低值提高到 90%或更高且无饱和度低于 90%以及生活质量改善来衡量，消除或显著减少 OSA 症状。从实际角度来看，如果没有患者的合作，尤其是在减肥和保持健康生活方式方面，实现这些目标可能极其困难。
