Alternative interventions for obstructive sleep apnea

Article Figures & Data

TABLE 1

OSA surgical procedures and reported outcomes

Procedure	Outcome
Nasal surgery alone	Limited efficacy; 15.8% success rate in patients with OSA with snoring and nasal congestion
Tracheostomy	100% success rate; 83% cure; morbid procedure; last resort
Laser-assisted uvulopalatoplasty	18% reduction in AHI
Radiofrequency ablation	34% reduction in AHI
Implants	25% reduction in AHI
Uvulopalatopharyngoplasty	33% reduction in AHI
Maxillomandibular advancement	87% reduction in AHI
Bariatric surgery	75% improvement in AHI

TABLE 2

Hypoglossal nerve stimulation indications and contraindications

Indications	Contraindications
• Age greater than 22 • Apnea-hypopnea index of 15-65 events per hour (< 25% central or mixed apneic events on polysomnography) • Body mass index < 32 kg/m2 • Failure of or intolerant to positive airway pressure therapy • Airway anatomy appropriate on drug-induced sleep endoscopy (no concentric collapse at retropalatal level)	• > 25% central or mixed apneic events on polysomnography • Anatomic findings that compromise performance (ie, complete concentric collapse) • Pre-existing condition that compromises neurologic control of the upper airway • Inability to operate the system • Pregnancy or planning to become pregnant • Require magnetic resonance imaging (in some cases)

TABLE 3

Oral appliance therapy indications and contraindications

Indications	Contraindications
• Younger age	• Recent or active orthodontics
• Lower body mass index	• Periodontally compromised dentition
• Smaller neck size	• Acute temporomandibular joint dysfunction
• Lower apnea-hypopnea index	• Unrealistic expectations
• Positional obstructive sleep apnea	• Uncontrolled seizure disorder
• Retrognathia	• Growth potential (orthodontist supervision)
• Good ability to advance mandible	• Limited ability to advance mandible