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NEUROLOGY &
SLEEP DISORDERS

soft palate to relieve obstruction of the airway. technique, referred to as upper airway stimulation, is accom-
When these treatment options are not tolerated or not effec- plished through a fully-implantable nerve stimulator system that
tive, surgical intervention may be warranted. Surgeries can be tar- the patient has control over with a bedside remote control. This
geted at multiple sites of the airway, including the nasal cavity, therapy is emerging as an alternative to PAP therapy for patients
tonsils and soft palate, tongue base, epiglottis, and the bony struc- with moderate or severe OSA who cannot tolerate other treat-
ture of the mandible and maxilla that house the upper airway. ments. There is currently one such nerve stimulator available on
However, it is important to understand that surgical treatment is the market with approval from the FDA, but others are under-
not always effective. In selected patients, an obvious source of going development and clinical trial.
obstruction such as tonsil hypertrophy can be effectively elimi- Obstructive sleep apnea is an important disorder that affects
nated with surgery. For others, increases in airway caliber and sta- both sleep quality and general health conditions, most notably
bility can be achieved to provide improvement in AHI or in the cardiovascular disease. Therefore, the importance of treatment
ability to tolerate PAP therapy because a lower treatment pressure is evident. For the vast majority of cases, the gold standard of
is needed. In other cases, curing OSA with surgery is sometimes PAP therapy should be attempted first. However, treatment is not
a near impossibility, but these surgical options may be the only always easy, so tailoring treatment to the individual patient is nec-
viable ones for a given patient. In this circumstance, surgery can essary to achieve the best result.
be thought of as a salvage treatment to provide as much relief as
possible to improve sleep quality for the patient and bed partner. Dr. Nicholas Scalzitti is the chief of the Sleep Surgery Division of the
An exciting new therapeutic target in treating OSA is augment- Otolaryngology Department at the San Antonio Military Medical Center.
ing the tone of the muscles that dilate the upper airway. This is He is board certified in both Sleep Medicine and Otolaryngology/Head and
currently done through neurostimulation of the hypoglossal Neck Surgery.
nerve branches that cause tongue stiffening and protrusion. This

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