Comparative evaluation of surgical treatment methods for adult patients with obstructive sleep apnea syndrome. (A systematic review. Part I)

In the domestic literature, despite the development of surgical treatment for obstructive sleep apnea syndrome (OSAS), no significant scientific studies devoted to the analysis of the effectiveness of various surgical techniques in the comprehensive treatment of patients with this pathology have been identified. Objective. To evaluate the effectiveness of surgical techniques in the comprehensive treatment of patients with OSAS based on a literature review. Material and methods. Surgical treatment methods for OSAS proposed in Powell-Riley protocol were selected. During the comparative analysis of the effectiveness of the methods, operations of stage I of the Powell-Riley protocol were divided according to the levels of upper airway (UA) obstruction: nasal surgery, retropalatal surgery (uvolopalatopharyngoplasty and its modifications) and retrolingual surgery (which included osteotomy of the mandible with advancement of the genioglossus muscle and advancement of the hyoid bone with myotomy). Among the operations of stage II of the Powell-Riley protocol, the use of orthognathic surgery with maxillomandibular advancement (OSMMA) was analyzed. The ffectiveness of each surgical technique was assessed separately in patients with moderate and severe OSAS based on a meta-analysis of published data from 2000 to 2014. Results. Success rate of isolated surgical techniques used in stage I of the Powell-Riley protocol was less than 50%. The effectiveness of orthognathic surgery with maxillomandibular advancement as stage II of the Powell-Riley protocol amounted to 88%. Conclusion. The low effectiveness of isolated stage I Powell-Riley procedures is associated with multilevel UA obstruction, which necessitates the use of multilevel surgery for the treatment of patients with moderate and severe OSAS. OSMMA showed high effectiveness as a method of stage II of the Powell-Riley protocol in the surgical treatment of patients with moderate and severe OSAS, suggesting its more frequent use in the comprehensive treatment of OSAS.