Clinical update of obstructive sleep apnea

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Clinical update information and experiences on obstructive sleep apnea (OSA) in the United States are presented.
Computerized acoustic analysis instrument (SNAP) is unique in regards to objective assessment and qualification of the snoring sound as well as the identification of its anatomical source. The majorities of patients tested were found to have loud uvulopalatal snoring and were directed towards palatal surgery. A small percentage of patients were found to have either light snoring or snoring of non-uvulopalatal origin and were advised against aggressive treatments or palatal surgery.
In many OSA patients, the airway lumen collapses at the hypopharynx or at multiple levels simulta neously. In such cases, surgeries that will enlarge the hypopharynx or prevent collapse of base of tongue are recommended and either performed alone or in conjunction with UPPP. These procedures include Genioglossus Advancement with Hyoid Myotomy Suspension (GAHM), Radiofrequency Volumetric Tongue Reduction, and Suture Anterior Tongue Suspension (REPOSE). The success rate of GAHM has ranged from 50 to 78%. The authors' success rate of GAHM was 66.6%. The REPOSE was initially proposed as a minimally invasive procedure designed to suspend the tongue with a suture from the genioglossus tubercle. But a multi-center trial study produced discouraging results, particularly in regards to reduction snoring. Most recently hyoid myotomy suspension using the REPOSE screw has been added to the armamentarium of procedures dealing with hypopharyngeal obstruction. Tongue and hyoid suspension can be performed simultaneously in conjunction with a UPPP for better results. Base of tongue volume reduction by submucosal application of radio frequency energy constitutes the latest method for dealing with hypopharyngeal and base of tongue collapse in OSA. In a pilot study, Powell et al clearly demonstrated the feasibility, safety and efficacy of radiofrequency application in reducing tongue volume. Somnoplasty (radiofrequency treatment of soft palate) for habitual snoring has been gaining popularity among otolaryngologist in USA since 1997. It is indicated only for habitual snoring without OSA. Our experience consists of 35 patients. Mean preoperative and, postoperative snoring scores using the Mickelson's snoring scale was 4.2 and 1.9 respectively. Approximately 75% of the patients treated with somnoplasty were considered good responders.