Staging and Treating Snoring and Obstructive Sleep Apnea

TORONTO-Obstructive sleep apnea (OSA) needs to be addressed as a multilevel disease, especially in patients who fail or can’t tolerate continuous positive airway pressure (CPAP). But more than that, often minimally invasive techniques and technology will solve the problem, rather than using aggressive surgery on only one level.

It’s not about the palate and tonsils only-it’s about the nose, palate, the tongue base, and sometimes the epiglottis. We have to address it with a multiple level of treatments, said Michael Friedman, MD, Professor of Otolaryngology at the Rush University Medical Center in Chicago, who moderated a session on the treatment of snoring and OSA at the annual meeting of the AAO-HNS.

Panelists included B. Tucker Woodson, MD, Professor of Otolaryngology at the Medical Collage of Wisconsin; David Terris, MD, Chair of Otolaryngology at Medical College of Georgia; and David L. Steward, MD, Director of Clinical Research in Otolaryngology-Head and Neck Surgery at the University of Cincinnati Medical Center.

According to Dr. Friedman, the first step is to determine how severe the disease is, and the otolaryngologist needs to take several factors into account in order to stage it. Staging is based on the anatomic site, and the type and severity of deformity. The extent of treatment-whether it’s minimally invasive, no treatment, or maximally invasive-is based on a combination of the deformity and severity of the disease.

A minor deformity causing a minor problem may typically call for a minor procedure, whereas a more significant deformity causing problems beyond just snoring may demand a more aggressive procedure, he said.

Classifying OSA

Dr. Friedman uses a classification system that incorporates three levels of staging for disease severity: 0, 1, and 2. Level 0 would be no disease (or possibly an anatomical variation that falls within the normal, healthy range), level 1 would be mild disease that could benefit from a minimally invasive technique, and level 2 is severe and would require an aggressive approach.

He discussed how the classifications and treatment rankings would work with the nose, palate, tonsils, hypopharynx and tongue base, and body mass index (BMI) of the patient.

With the nose, N0 would require no treatment. An N1 case could benefit from radiofrequency (RF) of the turbinate, or nasal valve repair. For N2, septoplasty is needed.

At this point, panelists were asked how they would treat a patient with an obvious nasal deformity such as a deviate septum or turbinate, and who had significant sleep apnea but no daytime symptoms.