The evolving landscape of sleep surgery: A state-of-the-art review.

OBJECTIVE

To review the evolution of sleep medicine and surgical management of obstructive sleep apnea (OSA), focusing on anatomy-based and individualized treatment strategies.

METHODS

This narrative review was developed by an expert panel of otolaryngologists and sleep medicine specialists. Landmark studies, consensus statements, and clinically relevant investigations were analyzed. Surgical approaches were classified according to anatomical target and functional mechanism, with particular attention to drug-induced sleep endoscopy (DISE), patient phenotyping, and multimodal treatment strategies.

RESULTS

Sleep surgery has progressed from highly invasive procedures to minimally invasive, function-preserving, and multilevel approaches. Advances in understanding upper airway anatomy and collapse mechanisms have enabled targeted interventions, including barbed pharyngoplasty, transoral robotic surgery, maxillomandibular advancement, and hypoglossal nerve stimulation. DISE has improved identification of obstruction patterns and individualized surgical planning. Current OSA management increasingly combines surgical, dental, behavioral, and medical therapies within personalized care pathways.

CONCLUSION

Modern sleep surgery has evolved toward precision-based, multidisciplinary management. Individualized anatomical and functional assessment is central to treatment selection, while emerging diagnostic and therapeutic innovations may further improve outcomes.