Alternatives for OSAHS treatment: selection of patients for upper airway surgery and oral appliances

Although continuous positive airway pressure (CPAP) is considered to represent the standard treatment for patients with moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS), poor treatment compliance and/or refusal is an issue in similar to 20-30% of these patients. As an alternative to life-long CPAP treatment, conservative procedures exist with dental appliances for mandibular advancement, as well as curative surgical techniques. Surgical treatment of OSAHS can be divided into the following two main groups: 1) upper airway surgery by soft tissue resection (uvulopalatopharyngoplasty, etc.), and 2) skeletal procedures, such as maxillo-mandibular advancement. Proper selection of patients for the different treatment modalities is the key for full treatment success. Patient-related factors, such as the site of upper airway collapse, craniofacial characteristics, dental health, obesity, age, profession and positional dependence, as well as treatment-related factors, should be evaluated before a final proposal for these treatment alternatives is formulated.