- Dept. Otolaryngology – Head&Neck Surgery HLA Moncloa University Hospital Valladolid Av. 83
- info@headneckroboticsurgery.com
WELCOME TO HEAD & NECK ROBOTIC SURGERY IN THE H&N
Obstructive Sleep Apnea (OSA) is a significant health issue with a profound impact on the quality of life for affected individuals. The microarousals triggered by obstructive events result in fragmented and non-restorative sleep, leading to daytime sleepiness and long-term consequences on the cardiovascular and respiratory systems.
OSA is defined by the occurrence of respiratory pauses during sleep caused by either complete (apnea) or partial (hypopnea) obstruction of the airway. These pauses are considered significant when they last for more than 10 seconds, with the normal frequency being fewer than 5 occurrences per hour. This frequency of events per hour is referred to as the Apnea-Hypopnea Index (AHI), which is considered abnormal when exceeding the threshold of 5 per hour. There are individuals who experience hundreds of such events throughout a single night.
In Spain, between 5 to 7 million individuals exhibit a pathological AHI, and it is estimated that between 1 to 2 million individuals suffer from clinically relevant OSA necessitating treatment.
Typically, a clinical suspicion will arise, often prompted by the most common symptom: snoring. Frequently, it will be the patient’s partner who initiates the diagnostic process. Based on the patient’s medical history, a level of suspicion will be established. The Epworth Sleepiness Scale can assist us in this regard, with individuals without OSA usually scoring less than 10.
You can assess your score using the questionnaire.
The diagnosis of OSA will be confirmed through a sleep study or polysomnography (PSG). Ideally, this study will be conducted in a clinical setting that allows us to include an electroencephalogram (EEG) in the recording. Nevertheless, various home-based recording systems have demonstrated utility. The results will validate the diagnosis of OSA, which may be classified as:
Patients with an AHI below 5 will be classified merely as snorers. However, this condition may still entail relationship issues and may also necessitate a therapeutic approach.
New screening devices are coming the market. Check some of them:
The drug-induced sleep endoscopy (DISE) of the upper respiratory tract will be conducted in patients with OSA for whom a surgical intervention is being considered. This structured procedure will provide supplementary insights beyond clinical examination, aiming to determine the requisite modifications in the upper airway of the patient to achieve optimal curative expectations. SEORL-CCC has recently issued a guideline outlining recommendations in this regard.
DISE is conducted within a controlled environment, such as an operating theater or an endoscopy suite, ensuring appropriate monitoring and adherence to safety protocols (see the protocol at HLA Moncloa).
Orthodontic devices, or oral appliances, can be effective in treating OSA. Some commonly used are:
Positional therapy. Devices:
Myofunctional Therapy (Oropharyngeal Exercises).
Continuous Positive Air Pressure (CPAP) systems are considered the standard treatment for OSA, and in some cases they may represent the sole option.
However, specific patients may either not tolerate or opt against CPAP treatment. In such instances, alternative approaches must be offered.
Surgical intervention for OSA aims to remodel the upper airway to ensure that the resulting anatomy, and particularly its dynamic behaviour, maintains airway patency during sleep. In the majority of patients, this necessitates surgical procedures targeting multiple anatomical levels. The range of possible techniques is extensive and must be tailored to the unique circumstances of each patient. Medical judgment is pivotal in ensuring the success of this decision-making process.
Commonly, upper collapses may warrant some form of pharyngoplasty. Lower collapses accompanied by excessive volume in the lingual tonsil can be addressed through resective techniques, such as robotic surgery. Certain patients may be candidates for Upper Airway Stimulation Systems.
Surgical options:
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