Velopharyngeal Complete Concentric Collapse in Patients with CPAP-Intolerant OSA: A Review of Management Strategies

Purpose of Review Velopharyngeal complete concentric collapse (CCC) is a relatively common yet difficult-to-treat collapse pattern in patients with obstructive sleep apnea (OSA). This review summarizes CCC prevalence and risk factors, as well as management strategies beyond continuous positive airway pressure (CPAP) including lifestyle modifications, current surgical approaches, and emerging treatment options. Recent Findings Complete concentric collapse occurs in 20–30% of OSA patients. Recent work on noninvasive approaches, adaptations in pharyngeal surgery and maxillomandibular advancement (MMA) have demonstrated evidence of utility in CCC. Emerging therapies such as bilateral hypoglossal nerve stimulation (HNS) and ansa cervicalis stimulation (ACS) have shown promising preliminary data in these patients. Summary Recent data on known nonsurgical and surgical options for CCC including pharyngeal surgery and MMA as well as novel therapies such as bilateral HNS and ACS is promising. Future work should focus on better defining the efficacy of such therapies in this population.