Multi-modality Therapy for OSA Disease Management; Personalizing Patient Care

PROGRAM DESCRIPTION: Obstructive sleep apnea (OSA) is a disease with significant physiologic and quality of life consequences, impacting a large portion of our population. As Otolaryngologists, we possess a unique understanding of upper airway anatomy and physiology central to this disease. We have the ability to provide both surgical and non-surgical treatment for OSA.

As we further our understanding of the pathophysiology of OSA, disease phenotypes, and develop new diagnostic and therapeutic options, we are able to provide care directed at the individual patient’s disease. The one size fits all approach to OSA has transitioned to a personalized, patient centric model.

A personalized care model allows for the assessment of factors leading to the individual patient's OSA, the review of treatment options and patient goals of therapy, assessment of non-OSA sleep disorders, and recommendations for treatment. This may employ surgery to optimize tolerance and effectiveness of non-surgical therapy, a combination of surgery and conservative treatment, or multi-site surgery.

The goals of the session are to utilize brief lecture and case-based discussions to highlight;
A) The role of nasal surgery in positive airway pressure (PAP) optimization.
B) The assessment and management of non-OSA sleep disorders which can impact OSA management. These include periodic limb movement disorder, insomnia, restless leg, among others.
C) Options for combined surgical and non-surgical treatment. Frequently, the outcomes of single site surgery can be optimized by employing additional non-surgical options. This may involve the utilization of positional therapy or a mandibular advancement device in addition to surgery.
D) Options for multi-level surgery. OSA is frequently related to multiple sites of upper airway collapse. Advanced physical exam and diagnostic techniques are useful in identifying these sites of obstruction and choosing appropriate surgical interventions. This may include the combined use of surgery for the palate, base of tongue, facial skeleton, hypopharynx, and/or neurostimulation.

OUTCOME OBJECTIVE 1: Screen and evaluate for comorbid non-OSA sleep disorders including periodic limb movement disorder, restless, legs, insomnia, among others. These can impact the outcome of OSA management and patient satisfaction of therapy.

OUTCOME OBJECTIVE 2: Understand options for surgical optimization of conservative therapy and combination surgical and non- surgical treatment of OSA.

OUTCOME OBJECTIVE 3: Understand options of multi-level surgery for treatment of OSA and their application.

BACKGROUND STATEMENT: In understanding the pathophysiology of OSA, non-OSA sleep disorders, and disease phenotypes, a one size fits all approach is an outdated idea. Patient centric care, designed to identify optimal intervention married to patient goals for treatment allows for individualized management plans.

Comprehensive Otolaryngology Track Statement :