BlueCross BlueShield of Tennessee Medical Policy Manual

Radiofrequency Tissue Volume Reduction (RFTVR) for the Treatment of Upper Airway Obstruction

DESCRIPTION

Radiofrequency tissue volume reduction (e.g., Somnoplasty® device) is a minimally invasive procedure that utilizes low-power, low-temperature radiofrequency energy to produce thermal lesions in the soft palate and base of the tongue as a treatment of obstructive sleep apnea (OSA). The objective of radiofrequency tissue volume reduction is to decrease the amount of redundant tissue. The procedure is performed in the physician's office using local anesthesia and takes approximately thirty minutes to complete. By means of a partially insulated electrode, radiofrequency energy is delivered into the area through the submucosal tissue to make one or several coagulation lesions. The treated tissue is naturally absorbed over the next four to eight weeks.

Standard surgical procedures (i.e., uvulopalatopharyngoplasty [UPPP] and maxillofacial procedures) have been found to improve symptoms in adults with clinically significant obstruction. Minimally invasive surgical procedures have limited efficacy with mild-to-moderate OSA and have not been shown to improve Apnea/Hypoxia Index or excessive daytime sleepiness in adults with moderate to severe OSA.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

Studies in peer-reviewed literature are lacking to determine if radiofrequency tissue volume reduction is as beneficial as medical management or other surgical procedures for the treatment of upper airway obstruction.

SOURCES

American Academy of Pediatrics. (2012). Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 130 (3), e714-e755. Retrieved August 29, 2019 from https://pediatrics.aappublications.org/content/pediatrics/130/3/e714.full.pdf,

American Academy of Sleep Medicine. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep, 33 (10), 1408-1413.

B├Ąck, L.J., Liukko, T., Rantanen, I., Peltola, J.S., Partinen, M., Ylikoski, J., et al. (2009). Radiofrequency surgery of the soft palate in the treatment of mild obstructive sleep apnea is not effective as a single-stage procedure: A randomized single-blinded placebo-controlled trial. Laryngoscope,119 (8), 1621-1627. Abstract retrieved April 7, 2021 from PubMed data base.

BlueCross BlueShield Association. Evidence Positioning System. (7:2020). Surgical treatment of snoring and obstructive sleep apnea syndrome. (7.01.101). Retrieved July 7, 2020 from https://www.evidencepositioningsystem.com/. (36 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  6/1/2000

MOST RECENT REVIEW DATE:  5/13/2021

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