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

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 symptomatic, moderate to severe obstructive sleep apnoea.2 3 Upper airway surgery (such as uvulopalatopharyngoplasty) may also be done, but evidence does not support its use.4 However, use of surgical procedures is widespread and increasing in Australia and elsewhere (such as the Nordic countries).5 6 We propose that upper airway surgery should not be first line treatment for obstructive …