Dr. Kezirian’s Blog

In the United States and many other countries, obstructive sleep apnea surgery is generally considered a second-line therapy for patients who do not tolerate or benefit from positive airway pressure therapy (for example, continuous positive airway pressure, or CPAP). This is based on two arguments: Surgery clearly has greater risks than CPAP Surgery does not… Read more »

UPDATE: a version of this has been accepted for publication as a letter to the editor in the medical journal Laryngoscope. Systematic reviews and meta-analyses are supposed to be high-quality reviews of the medical literature that represent the highest level of scientific evaluation and evidence. Unfortunately, all that glitters in not gold. I have written… Read more »

I am excited to announce that I have now started a new adventure in my career, joining the UCLA Department of Head and Neck Surgery. I have been fortunate to train and then work at outstanding places with such talented people. This move will be no different, as the UCLA team has consistently been one… Read more »

Earlier this month, the US Food and Drug Administration expanded the approved indications for the Inspire Upper Airway Stimulation system, raising the upper limit for body mass index from 32 to 40 kg/m2 and increasing the upper limit for the apnea hypopnea index to 100 events/hour. This has been met with some surprise by colleagues,… Read more »

Hypoglossal nerve stimulation is an important treatment option for patients with moderate to severe obstructive sleep apnea who cannot tolerate positive airway pressure therapy (for example, CPAP). The only currently-FDA-approved technology is Upper Airway Stimulation (Inspire Medical Systems, Golden Valley, MN), but multiple technologies are in human clinical trials or under development. One of these… Read more »

Since its FDA approval in 2014, the Upper Airway Stimulation system from Inspire Medical Systems has dominated the landscape of nerve stimulation in the treatment of obstructive sleep apnea. A number of companies have been involved in development of hypoglossal nerve stimulation technologies, and this month one of those companies (LivaNova) had publication of results… Read more »

I have written previously on this blog about our research highlighting the extremely low quality of published “systematic reviews” and “meta-analyses” in the otolaryngology and sleep surgery literature. We have shown that many studies do not adhere to established, accepted research methods for these studies, creating a dangerous situation where publications that pretend to be… Read more »

I am writing from our 28th Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring course in Orlando, Florida. This is our first in-person course since 2019, and it was wonderful to be together. I do think more and more educational events will be offered virtually, as it increases access for people who… Read more »

Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA) in almost all patients in my practice. There are rare cases where I may order mandibular respositioning devices (aka, oral appliances), but CPAP is the primary option, even in patients who specifically request surgical treatment. CPAP has many advantages over alternatives,… Read more »

Surgery for obstructive sleep apnea often involves surgery of the throat that removes, repositions, and/or tightens tissue. Although the goal is to improve or eliminate the sleep apnea, the risks include the potential to disrupt normal function, especially speech and swallowing. Fortunately, speech changes have always been rare, but changes in swallowing have always been… Read more »