Critical analysis of the results of Surgery in the treatment of snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea (OSA)

Surgery is widely considered to be the first-line therapy for "simple" snoring and moderate sleep apnea syndrome. Surgical treatment of severe obstructive sleep apnea (OSA) is currently generally considered to be second-line therapy after continuous positive airway pressure (CPAP) treatment. Many patients, however, find difficulty in complying with the continued long-term demands of CPAP treatment and seek a more definitive one-off solution to their sleep-related problem. Surgical therapy has been found useful for snoring, at least on subjective grounds; this has incited patient demand and led surgeons to expand its use for upper airway resistance syndrome (UARS) and possibly OSA. In this paper the surgical procedures of uvulopalatopharyngoplasty (UPPP), nasal surgery, and maxillofacial surgery are discussed and analyzed as they relate to the resolution of snoring, UARS, and OSA. There are many methodological problems in the published literature that make this analysis difficult. We feel that surgical therapy should be comparable to CPAP therapy, fulfilling the same analytical criteria in regard to measurement of severity and improvement of the disorder, as well as an equally sustained effect. Operative risk and side effects need to be clearly stated. Guidelines for future data collection and clinical trials of surgical procedures are proposed, and we recommend randomized prospective multicenter protocols and a registry of patients undergoing surgery for OSA so that long-term follow-up can be achieved.