Sleep Apnea
Surgery
There are different
treatment options for
obstructive sleep
apnea (OSA). Which
option is right for
you depend upon the
severity of your
sleep apnea (which is
determined from a
sleep study), the
physical structure of
your upper airway,
and other aspects of
your medical history.
The various options
are listed below so
that you can discuss
them with your
doctor. Only your
doctor or
sleep
specialist can tell
you which treatment
option is best for
you.
When thinking about
treatment options,
remember that with an
obstructive apnea,
there are physical
blockages or
obstructions in the
airway during sleep.
(In OSA, obstructions
occur during sleep
but not during waking
hours partly because
all muscles,
including the muscles
in the airway, relax
during sleep.)
Obstructions that
cause breathing to
stop completely for
at least ten seconds
are termed apneas.
When breathing is
substantially reduced
for at least ten
seconds, it is a
hypopnea.
Frequent apneas and
hypopneas lead to
numerous brief
awakenings during
sleep and to
sleepiness during
waking hours.
Preventing apneas and
hypopneas prevents
the sleep
fragmentation, so
treatment reduces the
sleepiness. (For
simplicity, here
"apneas" include
hypopneas as well.
For more on OSA, read
the American Sleep
Apnea Association
brochure "Get the
Facts about Sleep
Apnea.") All
treatment options are
intended to prevent
obstructions from
occurring, usually by
widening the airway.
Keep in mind the
precise cause of
obstruction is
usually difficult to
find, and many people
have obstructions in
more than place.
Uvulopalatopharyngoplasty,
or UPPP
A
procedure, which is
intended to enlarge
the airway by
removing or
shortening the uvula
and removing the
tonsils and adenoids,
if present, as well
as part of the soft
palate or roof of the
mouth. (The uvula is
the tissue that hangs
from the middle of
the back of the roof
of the mouth; the
word comes from the
Latin "uva" meaning
"grapes.") According
to the "Practice
Parameters for the
Treatment of
Obstructive Sleep
Apnea: Surgical
Modifications of the
Upper Airway," issued
in 1996 by the
American Academy of
Sleep Medicine
(formerly the
American Sleep
Disorders
Association), the
overall efficacy is
40.7%. A more recent
surgery using a laser
is performed for
snoring. There is not
yet enough
information to say
whether LAUP is
effective for OSA.
Radio
Frequency
Tissue
ablation (RFTA)
Somnoplasty
Another but
relatively new
surgical procedure
for sleep apnea, one
typically done in the
doctor's office, is
radio frequency
tissue ablation
(RFTA), with the
trade name
Somnoplasty. Approved
by the Food and Drug
Administration in
November of 1998, it
is to shrink the size
of the tongue and/or
palate. Multiple
treatments are often
necessary, and it may
be performed in
conjunction with
other therapies as
well. RFTA is still
viewed as a new
procedure, and
relatively little
published data on the
procedure are
currently available.
A different surgical
system designed to
treat OSA was
approved by the FDA
in February 1998.
Known as the tongue
suspension procedure
(with the trade name
Repose), it is
intended to keep the
tongue from falling
back over the airway
during sleep with a
small screw inserted
into the lower jaw
bone and stitches
below the tongue.
Usually performed in
conjunction with
other procedures,
this surgery is
potentially
reversible. No
studies on the
long-term success are
available, and little
clinical data to
demonstrate the
efficacy of the
procedure have yet
been published in a
peer-reviewed
journal.
In general, when
weighing surgery,
consider whether data
on the safety and
efficacy of the
procedure have met
the key standard of
being published in a
peer-reviewed medical
journal and whether
the cases studied are
similar to yours.
Surgery helps many,
but effectiveness
varies from person to
person. (With any
surgery, follow-up
sleep studies are
often adviseable.) If
unsure about
proceeding, you can
get a second opinion.
Only a doctor who has
examined you and your
airway can advise you
on having surgery.
There are additional
treatment options for
OSA that do not
require surgery,
including devices to
keep the airway open.
As mentioned, some
surgeries are
performed to make
using them more
comfortable. Which
treatment is right
for you depends upon
the severity of your
OSA and other aspects
of your medical
condition. Talk to
your doctor about
what is best for you,
and remember your
doctor may take a
step-wise approach to
treatment.
Physicians who
perform surgery for
sleep apnea are most
commonly
otolaryngologists
(specializing in the
ears, nose, and
throat) and oral and
maxillofacial
surgeons. If you are
seeking a referral to
a surgeon or a second
opinion, you may find
one through your
physician or through
a sleep center, and
keep in mind that
your insurance policy
may require you to
get a referral for a
specialist and/or to
see a specific
provider.
If you
think you or a
loved one may
have
symptoms of a
sleep disorder,
please
contact us
today.
Help
is available!
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