Controversies in OSA Pathophysiology, Diagnosis and Treatment (2022 AMW)
2022 AAO-HNSF Annual Meeting & OTO Experience
The pathogenesis of OSA is multifactorial. Recently identified four physiological traits include upper airway collapsibility, poor muscle responsiveness, low arousal threshold, high loop gain. The pharyngeal collapsibility (measured by Pcrit) is considered a key endotype of OSA pathophysiology. The controversies about the different methods for the identification of anatomical and non-anatomic OSA phenotype traits including CPAP dials in sleep labs, the mean inspiratory flow during flow limitations, the airflow shapes, the negative expiratory pressures, the diagnostic PSG findings, and recent advances in imaging techniques, photogometry, acoustic analysis of snoring are discussed. Drug-Induced Sleep Endoscopy has been employed to assess upper airway obstruction during apnoea since its introduction in 1990. In the last three decades, considerable development and progress have been made in fine-tuning this procedure and addressing various controversies. The role of DISE is discussed and updated. OSA treatment has undergone significant changes in recent years, other than the CPAP therapy. The main non-invasive treatments include intraoral negative airway pressure or mandibular advancement device. Palatal surgical procedures include minimally invasive radiofrequency, pillar implants, and modified pharyngoplasties. Tongue surgery has also been changed from minimal invasive radiofrequency, tongue suspension, and tongue base resection by coblation or robotic-assisted surgery. Finally, the conventional maxillo-mandibular advancement is developing in its minimal invasive version. Based on the clinical evidence of these new treatments, choosing suitable treatment modalities for OSA patients will be debated.
Credits
CME:1.0, MOC:1.0