Treatment Modalities for Obstructive Sleep Apnea (Multi-Level Surgical Approaches in OSA)

Abstract

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent episodes of upper airway collapse during sleep, resulting in intermittent hypoxia, disrupted sleep architecture, and reduced quality of life. Although continuous positive airway pressure (CPAP) remains the standard first-line therapy, its long-term use is often limited by patient intolerance or poor adherence. Surgical intervention offers an effective alternative, particularly for patients with anatomical contributors to airway obstruction or those unable to tolerate CPAP therapy. Multi-level surgical approaches have gained increasing clinical importance as OSA commonly involves obstruction at more than one anatomical level, including the nasal airway, oropharynx, and hypopharynx. Identification of collapse sites through drug-induced sleep endoscopy (DISE) has improved surgical planning and individualized treatment. Multi-level surgery aims to enlarge airway lumen, reduce collapsibility, and restore airway stability during sleep, leading to improved respiratory parameters and enhanced health-related quality of life.