Assessment of obstruction level and selection of patients for obstructive sleep apnoea surgery: an evidence-based approach

Introduction: Obstructive sleep apnoea has long been recognised as a clinical syndrome: however, high quality evidence on the effects of surgery for this condition is still missing. Despite this, a consensus seems to be evolving, albeit based oil limited evidence, that surgery should be offered as a second line treatment to suitable patients with obstructive sleep apnoea. Aims: This article aims to assess the different methods of investigating upper airway obstruction in patients with obstructive sleep apnoea, in respect to these methods' relevance to surgical treatment, via a systematic review of the literature. Methods: The Cochrane Controlled Trials Register, Medline and EMBASE were searched from 1966 onwards. The search was performed in August 2008. A total of 2001 citations were retrieved. Results and conclusion: There is not yet a generally accepted way to assess Surgical candidacy based oil the level of obstruction. Better organised clinical studies with well defined endpoints are needed. In the meanwhile, it appears that sleep nasendoscopy. acoustic reflectometry and pressure catheters can all provide useful information, and their use may be decided upon based oil the experience and resources available in individual departments.