Current Views on the Efficacy of Surgical Methods for Treating Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is not only a widespread pathology, but also has far-reaching social consequences due to the poor quality of patients’ nocturnal sleep and high levels of daytime sleepiness. Many methods for treating OSAS have now been developed, both conservative and surgical. Operations performed for OSAS seek to correct the structures of the nose, pharynx, and larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite a history of 75 years of surgical treatment, there is still a lack of clarity regarding the appropriateness of certain types of operations. The current article presents data from meta-analyses published over the past 10 years addressing various types of surgical interventions aimed at combating OSAS in the adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the mandible in adults, expansion of the maxilla in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, procedures for laryngomalacia, and bariatric surgery are considered. Data on the efficacies of the most common operations are presented: tonsillectomy in adults (85%) and multilevel pharyngoplasty (60%); there is a wide range of results relating to the efficacy of uvulopalatoplasty – from 25% to 94%. This article discusses effective surgical options and the criteria for a positive prognosis of such treatment, as well as the possibility of complete cure of OSAS, i.e., reductions in the apnea/hypopnea index (AHI) to <5 events/h in adults. In conclusion, the need for continued research using the Sher criteria for the efficacy of surgical operations is emphasized: reductions in AHI by 50% or more or to below 20 events/h. Studies including long-term postoperative follow-up are of particular importance. © 2024 Elsevier B.V., All rights reserved.