Mark A. D’Agostino MD, FACS, Editor

The economic impact of untreated sleep apnea is staggering and is felt far and wide, not only on the amount of health care dollars spent on untreated apneic patients but also on its effect on the workforce in terms of decreased productivity, work days lost, and disability.

The health consequences of untreated apnea have become more and more apparent over the years. Untreated apnea can be associated with the development of cardiovascular disease (including hypertension, congestive heart failure, arrhythmias, and strokes), insulin resistance, cognitive impairment, and increased markers of inflammation.

I am pleased to present this issue of Otolaryngologic Clinics of North America dedicated to obstructive sleep apnea. I am honored to have assembled a group of national experts to discuss the diagnosis and treatment of patients with obstructive sleep apnea. In the following articles, we review the use of both in-lab and home sleep testing and the role of each in diagnosis, review the use of drug-induced sleep endoscopy to assess the collapsibility of the upper airway, and discuss the treatment options of positive airway pressure, oral appliances, and surgery. Obstructive sleep apnea in the pediatric population is also addressed.

The field of sleep surgery has grown rapidly over the last several years, from the classic uvulopalatoplasty initially described by Fujita to the numerous palatal procedures currently available to the otolaryngologist. Based on earlier studies by Scher and others, we have come to realize the importance of addressing the base of the tongue along with the palate when treating patients with apnea.

Numerous procedures to address the base of tongue have been developed and are addressed here. I am especially excited to present the latest advances in addressing the base of tongue, including transoral robotic partial glossectomy and hypoglossal nerve stimulation therapy.

Hypoglossal nerve stimulation therapy is a novel approach to obstructive sleep apnea and may revolutionize the way obstructive sleep apnea is treated.

There is no doubt that the field of sleep medicine, and specifically obstructive sleep apnea, will continue to grow, and the otolaryngologist will continue to play a pivotal role in diagnosing and treating these patients.