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

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

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

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

Key points 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 clinical problem

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]

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Rapid Responses:

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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]