Western University Protocol for Obstructive Sleep Apnea

Introduction: Obstructive sleep apnea (OSA) is a prevalent disorder in the adult population characterized by recurrent upper airway obstruction during sleep, resulting in intermittent hypoxia, sympathetic activation, and sleep fragmentation. It is linked to significant cardiovascular, metabolic, neurocognitive, and psychosocial morbidity. There is increasing evidence that continuous positive airway pressure (CPAP) adherence remains suboptimal in many patients and in those patients, surgery is often indicated. Methods: This review presents an updated, protocol-driven surgical approach grounded in clinical evidence and experience, highlighting the role of drug-induced sleep endoscopy (DISE) and personalized multi-level interventions for adult patient with OSA. Integration of anatomical phenotyping and DISE-directed planning enables precise surgical targeting. The protocol emphasizes patient selection, individualized treatment based on obstruction patterns, and perioperative optimization. This surgical algorithm improves success rates and long-term outcomes in patient’s intolerant of CPAP therapy. Results: A DISE guided, and multilevel surgical approach include: uvulopalatoplasty, septoplasty, tongue base reduction, palatoplasty and maxillomandibular advancement (MMA). Preoperative assessments include BMI and the STOP BANG along with Epworth Sleepiness scale, while postoperative care emphasizes follow up polysomnography and adjunctive therapies only when necessary. Regional experiences in Saudi Arabia and Canada underscore the importance of standardized, evidence-based surgical care. Conclusion: The purpose of this article is to establish a clear protocol for managing patients diagnosed with OSA, drawing from a review of existing literature and the insights of experienced surgeons in the field of sleep apnea, and updating current protocols with modern evidence.