Due to its prevalence, symptoms such as daytime sleepiness, increased risk of accidents, cardiovascular consequences, and the reduced prognosis, obstructive sleep apnoea (OSA) is highly relevant for individual patients and societies. Weight reduction should be recommended in general for obese OSA patients. Continuous positive airway pressure (CPAP) has proven to normalise respiratory disturbances and clinical findings and improve comorbidities and outcome. Although CPAP is not associated with serious side-effects, a relevant number of patients report discomfort, which may limit treatment adherence. Therefore, there is a huge interest in alternative conservative and surgical treatment options. The highest level of evidence can be described for mandibular advancement devices which can be recommended especially in patients with mild-to-moderate OSA, and in patients who fail to accept CPAP despite sophisticated attempts to optimise device, interface, and education. Hypoglossal nerve stimulation might be an interesting option in individual patients. Tonsillectomy is indicated in both children and adults with occluding tonsil hypertrophy. In addition, maxillomandibular osteotomy has been shown to sufficiently treat OSA in the short and long-term. Other surgical options including hyoid suspension, genioglossus advancement, and multilevel surgery might be used in carefully selected, individual cases if other options have failed.
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