Systematic Evaluation of the Sleep Surgery Patient: The Penn Protocol

PROGRAM DESCRIPTION: Obstructive sleep apnea is increasing in prevalence in the United States and abroad. While CPAP is often the 1st line treatment, greater than 50% of patients have difficulty tolerating it on a consistent basis. Patients often seek care from comprehensive and academic otolaryngologists alike to help manage their obstructive sleep apnea, making this a common presenting complaint within otolaryngology. The etiology of obstructive sleep apnea is often complex, requiring a strong understanding of a patient’s upper airway anatomy and physiology in order to appropriately and successfully manage these patients. In this way, a systematic clinical approach is critical to match therapeutic options to the underlying pathology.
In this session, four sleep otolaryngologists will detail the comprehensive, standardized work up and management of the OSA patient through a series of case-based presentations. Careful review of sleep studies with a focus on aspects other than the AHI are crucial in directing clinical management and assisting with patient selection, particularly for hypoglossal nerve stimulation. We will discuss the complete upper airway physical exam with a focus on the skeletal framework, as otolaryngologists often focus their exam on the nasal cavity and soft tissues of the oropharynx, while overlooking the craniofacial skeleton, an increasingly recognized entity in the surgical OSA management. We will also discuss supine endoscopy in the clinic as well as optimizing the drug-induced sleep endoscopy. Finally, we will describe advanced work up including the utility of our standardized CT sleep protocol as well as drug-induced sleep endoscopy with positive airway pressure in patient selection. Through a series of case-based presentations, the audience will learn to recognize exam findings that may impact a patient’s treatment options and most importantly, improve sleep surgery outcomes.

OUTCOME OBJECTIVE 1: Recognize important features of sleep studies that can guide surgical intervention and patient counseling.

OUTCOME OBJECTIVE 2: Implement a comprehensive OSA clinical and endoscopic exam with careful evaluation of dentoskeletal anatomy with an understanding of how this may impact clinical decision-making.

OUTCOME OBJECTIVE 3: Interpret drug-induced sleep endoscopy findings and understand how this may dictate treatment options as well as affect patient counseling regarding surgical outcomes.

BACKGROUND STATEMENT: This panel will address one of the “promoted gaps” – surgical challenges and failures in the management of OSA – with a more thorough understanding of the skeletal anatomy as well as upper airway physiology to optimize patient outcomes.