BMJ  2008;336:44-45 (5 January), doi:10.1136/bmj.39381.509213.AE

Practice

Change Page

Upper airway surgery should not be first line treatment for obstructive sleep apnoea in adults

Adam G Elshaug, lecturer1, John R Moss, associate professor and head1, Janet E Hiller, professor of public health1, Guy J Maddern, director of surgery2

1 Discipline of Public Health, University of Adelaide, SA 5005, Australia, 2 Queen Elizabeth Hospital, Woodville, SA 5011, Australia

Correspondence to: A Elshaug  adam.elshaug@adelaide.edu.au

The first 150 words of the full text of this article appear below.


Upper airway surgery for obstructive sleep apnoea in adults is resource intensive with low and inconsistent clinical effectiveness
Continuous positive airway pressure (CPAP) plus conservative weight and alcohol management should be first line treatment
When CPAP treatment fails, mandibular advancement devices may be considered (with conservative management) as second line treatment
Surgery for obstructive sleep apnoea should be done within controlled clinical trials; patients should be informed about the trial, as well as of the inconsistent results of surgery, its potential side effects, and the potential for relapse


The prevalence of obstructive sleep apnoea in high income countries is estimated to be 20% for mild disease and 6-7% for moderate or severe disease. The condition is associated with multiple morbidities, motor vehicle crashes, and reduced health related quality of life.1 Clinical guidelines recommend continuous positive airway pressure (CPAP) with weight and alcohol management (if indicated) as first line treatment for . . . [Full text of this article]


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Elshaug, A G, Hiller, J E, Moss, J R (2009). Exploring policy makers' perspectives on a clinical controversy: airway surgery for adult obstructive sleep apnoea. Qual Saf Health Care 18: 397-401 [Abstract] [Full text]  
  • Khan, A., Ramar, K., Maddirala, S., Friedman, O., Pallanch, J. F., Olson, E. J. (2009). Uvulopalatopharyngoplasty in the Management of Obstructive Sleep Apnea: The Mayo Clinic Experience. Mayo Clin Proc. 84: 795-800 [Abstract] [Full text]  
  • Moore, K. E. (2009). Oral Appliance Therapy and Surgical Treatment of Obstructive Sleep Apnea. ACCP Sleep Med Brd Rev 4: 249-258 [Full text]  

Rapid Responses:

Read all Rapid Responses

Modern upper airway reconstructive surgery has a significant role in the treatment of adult obstructive sleep apnoea
Sam Robinson
bmj.com, 5 Jan 2008 [Full text]
Claim that modern upper airway surgery is as effective as CPAP to prevent death and cardiovascular morbidity in obstructive sleep apnoea
Arthur Dawson
bmj.com, 7 Jan 2008 [Full text]
Author reply to Sam Robinson
Adam G Elshaug, et al.
bmj.com, 7 Jan 2008 [Full text]
Change?
Edward M. Weaver
bmj.com, 8 Jan 2008 [Full text]
Sam Robinson's reply to Adam Elshaug
Sam Robinson
bmj.com, 8 Jan 2008 [Full text]
No problem; no change
Neville Shine
bmj.com, 9 Jan 2008 [Full text]
In Agreement, BUT...
Kent E. Moore, M.D., D.D.S.
bmj.com, 11 Jan 2008 [Full text]
Sleep Surgery Survival Study - Clarifications
Edward M. Weaver
bmj.com, 11 Jan 2008 [Full text]
Sleep Surgery Cardiovascular Outcomes Study - Clarifications
Edward M. Weaver
bmj.com, 11 Jan 2008 [Full text]
Therapeutic nihilism
Edward M. Weaver
bmj.com, 11 Jan 2008 [Full text]
Elshaug et al. reply
Adam G Elshaug, et al.
bmj.com, 22 Jan 2008 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ