Surgical Indications

Indications for surgery are defined in Table 1. All patients require a comprehensive evaluation to determine if they meet the criteria for surgery. Polysomnography as well as a history and physical examination are essential to make this determination. The subgroup of patients whose apnea-hypopnea index (AHI) is less than 20 may still be candidates for surgery. Surgery is considered appropriate if these patients have associated EDS, which results in altered daytime performance or comorbidities as recognized by the Center for Medicare and Medicaid Services (including stroke and ischemic heart disease). For those patients whose EDS is not explained by the severity of their sleep apnea or resolved with CPAP therapy, consideration may be given to obtaining a multiple sleep latency test or the maintenance of wake-fulness test to determine other etiologies of sleepiness (18,19). In these patients, surgery is unlikely to be beneficial. Other factors exist, which could predict poor surgical outcomes and consequently, render a patient to be unsuitable for surgery. These factors are listed in Table 2.

Sleep Apnea

Sleep Apnea

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