**4.5 Tracheostomy**

The most immediate, effective and definitive treatment for OSA is placing a permanent cannula in the neck to bypassing the upper pharyngeal airway. Patient will be able to breath, speak and eat by capping the tube during waking time and open the cannula during sleep. Tracheostomy significantly decreases apnea index, oxygen desaturation index, sleepiness, and mortality in OSA patients [28].

It requires a long-term care to reduce complications (e.g., pneumonia, mucus plugging, peristomal infections). Therefore, it is recommended primarily for patient with sever and life threating OSA who failed all the other treatment options and in morbid obese patients.
