Non-pressure therapies for obstructive sleep apnea: surgery and oral appliances.

The first-line treatment of obstructive sleep apnea (OSA) is positive airway pressure (PAP). If PAP fails to adequately treat the OSA, oral appliances that enlarge the airway (mandibular advancement devices primarily, or the tongue retaining device if the patient has no dentition) are the next line of therapy. The third-line treatment of OSA is surgery. Surgeries that have been used to treat OSA include septoplasty, tonsillectomy adenoidectomy, uvulopalatopharyngoplasty, mandibular advancement procedures, tongue reduction surgery, hyoid bone suspension, maxillofacial surgery, and bariatric procedures. There are scant data to support or compare the various procedures.