characterized by the occurrence of upper airway
obstruction during sleep at the pharyngeal level
with intensified activity of respiratory muscles.
Respiratory rhythm slows down during sleep and
a decrease in muscular tension of soft palate
muscles, along with the uvula, tongue, and the
posterior pharyngeal wall, occurs. This results in
retraction of the tongue and approaching of pha-
ryngeal walls. In addition, gravitation in the
supine position during sleep changes the position
of the mandible, further decreasing in the pha-
ryngeal space, especially in obese patients with
accumulated adipose tissues in the submandibu-
lar region. The OSA-predisposing risk factors
comprise obesity, mainly the deposition of adi-
pose tissues in the neck, short and large neck,
the structure of and anatomical changes in, the
upper airways and craniofacial region (long soft
palate, palatine adenoid tonsils, nasal polyps,
nasal septum bending, long uvula, large tongue,
elongated hard palate, maxillary protraction,
body shortening and elongation of maxillary
ramus, increment in mandibular angle, and
excessive curvature of the thoracic spine), and
the use of stimulants and medications reducing
muscle tension (De Backer 2013 ; Sutherland
et al. 2012 ; deBerry-Bobrowiecki et al. 1998 ;
Lowe et al. 1986 ).
The adult incidence of OSA ranges from 3 to
7 %, depending on the gender and the subgroup
characterized by different risk of this medical
condition (Lurie 2011 ; Punjabi 2008 ). Longitu-
dinal cohort studies show that a 10 % increase in
body weight causes a 6-fold increase in the risk
of moderate-to-severe OSA. A 5-year follow up
study has shown that gender plays a significant
role in the occurrence of OSA symptoms in
middle-age patients (11.1 % in men and 5.9 %
in women). Men with a 10 kg increase in body
weight show a 5.2-fold risk of higher apnea/
hypopnea index (AHI), over 15 events per hour,
while in women this risk is a 2.5-fold higher.
2 OSA Diagnosis
According to the American Academy of Sleep
Medicine Task Force Report (AASM 1999 ),
OSA is recognized on the basis of the following
specific diagnostic criteria: at least 5 events of
obstruction of the upper airways per hour of sleep
(AHI>5), excessive daytime sleepiness or at
least two other symptoms, such as interrupted
breathing or suffocation during sleep, recurrent
arousal from sleep, sleep providing no relaxation,
daily fatigue, and concentration difficulty. Three
types of OSA have been identified: mild –
characterized by the occurrence of fewer than
15 apnea/hypopnea events during sleep (AHI
<15) and the patient’s involuntary sleepiness
during activities that require little attention; mod-
erate – the number of apnea/hypopnea events
ranges between 15 and 30 (AHI – 5–30) per
hour and involuntary sleepiness occurs in
activities that require some attention; and severe
OSA – when over 30 apnea/hypopnea events per
hour of sleep occur (AHI>30) and involuntary
sleepiness during activities that require more
active attention during daytime.
Polysomnography is the gold standard test for
OSA diagnosis due to its ability to identify
parameters described in the OSA definition. The
excessive daytime sleepiness (EDS) is routinely
measured by the Epworth Sleepiness Scale (ESS)
(Johns 1991 ). If 10 OSA events occur per hour of
sleep and persists each time longer than 10 s then
OSA can be diagnosed.3 OSA TreatmentAs mentioned above, surgical and conservative
techniques find their application in OSA treat-
ment. Life style changes, body mass reduction,
giving up stimulants and medication that has an
effect on breathing (behavioral treatment) play a
significant role in the OSA treatment (Campbell
et al. 2015 ; Sharples et al. 2016 ; Carra
et al. 2012 ; Hoffstein 2007 ; Padma et al. 2007 ).
Surgical treatment is recommended only in cases
of abnormal anatomy predisposing to the devel-
opment of OSA and in hypertrophic changes. Of
the surgical techniques applied, the following are
worthwhile to emphasize: uvulopalatopharyngo-
plastics, i.e., techniques involving a partial resec-
tion of the soft palate, uvula, and palatal arches;64 J. Kostrzewa-Janicka et al.