Ewa Olszewska

1. As sleep disorders become more prevalent, how do you see advancements in surgical techniques transforming the treatment landscape? 

I believe that the main change is not in the prevalence, even though the increase in obesity does increase the OSA risk. However, the major change is becoming aware of this problem. It is actually highly prevalent. The majority of patients have not been diagnosed. Increased awareness and availability of sleep professionals, and diagnostic facilities will show the true magnitude of Obstructive Sleep Apnea (OSA). The primary treatment modality is not surgery, it is positive airway pressure therapy (PAP). PAP availability and acceptance can make a big difference in the treatment of OSA. However, PAP compliance is low. Therefore other non-invasive methods and surgery are becoming more and more utilized for the treatment of OSA. Advancements in surgical techniques are mainly moving away from ablative methods to more functional methods. These advancements not only have fewer complications and sequelae, but they are also much more effective in treating OSA. 

 2. What role do you think emerging technologies, such as AI and personalized medicine, will play in diagnosing and treating sleep disorders?

There is a lack of adequate resources in the diagnosis of sleep disorders. AI is expected to reduce the need for skilled manpower, particularly in performing and interpreting sleep studies. Moreover, AI will help utilize multimodal diagnostic technique results in order to personalize the treatment options, for faster and more effective treatment delivery and for successful outcomes.

3. With the increasing focus on minimally invasive procedures, are there any groundbreaking surgical innovations on the horizon that could revolutionize sleep medicine?

There are many methods currently being investigated. Major advancements will probably come from making the neural stimulation of the tongue and/or submental muscles via less and less invasive techniques.   

4. How do you envision the integration of surgical treatments with non-invasive therapies like wearable devices and behavioral interventions in creating comprehensive solutions for sleep disorders?

We all know that a single modality of treatment, whether it is PAP, positional therapy, MAD, or surgery has relatively limited efficacy. Individualizing the treatment by finding the best combination that would fit a patient’s anatomy, physiology, needs, tolerance and acceptance will increase its overall success.  

Advancements in surgical techniques, as well as other treatment methods, go through innovative processes. Innovation goes through work on the bench (including animal and cadaver work), translational studies, and clinical trials. Prior to clinical trials, surgeons often need to try modifications or novel approaches to surgery. Any such approach brings ethical concerns. If there were no such innovative approaches and trials, meaning if surgeons did what was done in the past, let alone advancements in the field of sleep surgery, this field would have never been established. However, it is extremely important to provide extensive information on the background and planned novelties to the patients, and get adequate informed consent. In addition, especially when these modifications and novelties have risks, it is the surgeons’ interest to protect both the patient and her/his professional practice, to seek approval of institutional institutional review boards and/or ethical committees.