The role of the tongue base in obstructive sleep apnoea

Obstructive Sleep Apnoea (OSA) is a globally prevalent health concern associated with severe neurocognitive and cardiovascular implications. Despite affecting approximately 1 billion adults globally, the condition remains underdiagnosed, emphasising the need for accessible diagnostic methods and effective treatments. While there are multiple sites of airway obstruction during sleep, the tongue base is recognised as the key role player in the pathogenesis of OSA. The tongue base could be visualised as the gateway for airflow between the upper airway (pharynx) and the tracheo – bronchial airway (of the lungs). Various treatment modalities, such as Continuous Positive Airway Pressure (CPAP), Mandibular Advancement Devices (MADs), Hypoglossal Nerve Stimulation (HNS), and Maxillomandibular Advancement (MMA) surgery, will ultimately have an effect on the anatomical position and function of the tongue and its extrinsic muscular foundation attachments. Thus, medical or surgical modulation of airflow through the upper pharyngeal airspace is entirely dependent upon the response of the tongue base to these interventions. The elimination of apnoea and improvements in its sequelae makes CPAP the gold standard for OSA. While CPAP effectively splints the tongue base in a forward direction, patient adherence remains a significant issue. This paper addresses the limitations and challenges associated with each method, advocating for sustainable and accessible solutions. Furthermore, the paper introduces a polypropylene tongue suspension device as a potential non-invasive alternative to orthognathic surgery, demonstrating promising results in reversing OSA by advancing the tongue base. This concept, currently under investigation, presents an exciting prospect for future OSA treatment options.