Posted on 10/24/2007 12:11:25 PM PDT by crazyshrink
Oral surgery can reduce CPAP needs in patients with sleep apnea (Chicago, IL, October 24, 2007) — A procedure known as uvulopalatopharyngoplasty (UPPP) may help some patients improve or even eliminate their obstructive sleep apnea (OSA), according to a new study. The research, presented at CHEST 2007, the 73rd annual international scientific assembly of the American College of Chest Physicians (ACCP), says the procedure, which removes excess tissue in the throat or mouth to widen the airway, can reduce the amount of treatment required by patients with OSA. In addition, researchers say UPPP also can eliminate OSA completely in some patients.
“Continuous positive airway pressure, or CPAP, is a well-established treatment for sleep apnea,” said lead study author Akram Khan, MD, Assistant Professor, University of Florida Jacksonville, “and while most patients tolerate it well, some are unable to tolerate it or don’t want to, and those patients need alternative means of treatment.”
To determine if UPPP provided improvement in sleep parameters, Dr. Khan and his colleagues from the Mayo Clinic, Rochester, MN, evaluated the success of the procedure in 63 patients aged 18-80, with OSA, over a 7-year period. All patients underwent UPPP and were assessed with polysomnography within a 6-month period, pre-procedure and post-procedure.
Results showed that UPPP eliminated OSA in approximately one quarter to one-third of patients, depending on the definition of success. Of those who experienced residual OSA and returned to CPAP use, the required CPAP setting was modestly lower. In addition, researchers reported that UPPP also reduced the mean apnea-hyponea index in patients.
“The apnea-hyponea index basically tells us the number of times a patient with sleep apnea quits breathing per hour,” Dr. Khan explained. “We found that the surgical procedure reduced patients’ apenic (nonbreathing) episodes by more than half.” According to Dr. Khan, UPPP provided an improvement in oxygen levels and other parameters of sleep, as well.
First described in 1981, UPPP has been used widely with varying results. Though researchers are unclear on what characteristics make up the ideal UPPP candidate, they suggest that patients with mild OSA, who are relatively young, lean, and healthy, may have the best results with this procedure. Researchers also believe that a decrease in CPAP requirements would likely improve compliance in patients who don’t have their OSA completely resolved.
“Obstructive sleep apnea increases the risk of other illnesses, such as heart disease, high blood pressure, and stroke, among others,” said Alvin V. Thomas, Jr., MD, FCCP, President of the American College of Chest Physicians. “Patients and physicians need to work together to recognize the signs of sleep apnea and to identify which method of treatment is most suitable.”
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I’ve been on a CPAP for three months now. I can’t sleep without it. I feel like a new man. I am not fat, never was. I have a lot of tissue in my mouth, throat and sinuses. I stopped breathing 67 time an hour during my sleep study.
I’m single though and a little concened about finding someone who won’t have a problem with a guy who hooks himself up to a machine every night.
My Lunatic daughter lost 85 pounds by moving her rather large ass a couple of miles a day. The problem that you may have is the big, the one the big one, work out.
I got pregnancy related sleep apnea, it went away about a year after the baby was born, I got it again with baby #5, and it never went away.
I solved it by sleeping sitting up! Anyone else have success with that? I sleep sitting up, or at least on a wedge. Works great for me.
Had that done in 1995. It hurt like the devil for two weeks. Then it worked pretty good until 2006 and I had to go back on the CPAP. They told me when I had the CPPP surgery that it would not last forever. CPAP masks have to be changed every 6 months to work well and that is covered under my insurance. It helps you to sleep deeply again.
Google “used CPAP machines” and you can find a CPAP for less than $150.
VA has provided me with a home hospital bed to try to reduce swelling of my feet. I have been through three sleep apnea test and was scheduled for another. The bed has little or no effect upon my feet, but being able to sleep with my torso elevated has completely alleviated any sign of the sleep apnea. My quality of life is so much better as a result. The CPack was too claustrophobic for me and I was worse off when I used it.
Wear a fanny pack with a couple of tennis balls in it.
It may sound funny but it (apparently, according to my wife) worked for me. However I like sleeping on my back and finally went for the CPAP. Didn't see how I was going to get used to it but after a week I wanted to kick myself for not doing it sooner.
Amen. Mine had been going on for so long I forgot what a good nights sleep was and thought feeling like I did was "normal".
I also understand when you stop breathing and then all of a sudden have to wake up to start again it triggers the flight or fight response and dumps a load of adrenaline which in turn increase blood pressure.
Not only that but do it enough and pretty soon you're awake and can't go back to sleep.
Just my thought, never seen anything medical that supports the second part.
I thought the same thing, didn't see how I'd ever get used to it.
Took about a week and after the first good nights sleep in I don't know how long I was hooked. There's also a side benefit in that the CPAP air is filtered and it seems to help my allergies.
There are a variety of different masks. I watch TV with mine on and I thought the hose down the middle would drive me nuts so I got one that attaches from the bottom. They can't be returned but I found several outfits that would give you return insurance so it wouldn't be a total loss if it didn't work out.
Nor is there any noise to speak of.
As others have already stated UPPP is nothing new, has been done for many years. The results for OSA are mixed depending on the level of obstruction. Even in cases where the sleep test show initial improvement the success may not last. The best results depend on proper diagnosis. If the level of obstruction is below the nasopharynx (past the UPPP level) then success will probably not be as good. Also if the obstuction is above (such as deviated nasal septum, polyps, enlarged turbinates) these can be treated with less pain. The UPPP really hurts and can result in regurgitation upon swallowing (fluids going upstream into nose). Bottom line don’t take this article as the panacea for OSA. See a good ENT or Oral Surgeon and insist on proper diagnosis. There are many procedures for OSA and simple snoring which usually means none are the be all and end all. The best studies IMHO are from a couple of Docs at Stanford, one is named Riley and I can’t remember the other.
There are a lot of different mask models. If one does not work try another. They make some that are just nose, some are just mouth, some are whole face. I believe Respironics makes over 20 different models.
It’s a really serious issue, don’t ignore it. The machine is very white-noise, you will get used to it in no time and the good night’s sleep will be worth it.
I was all lined up for a sleep study, I snored, and (worse) would often hold my breath.
In the meantime, Doctor put me on blood pressue medications.
To make a long story short, my sleeping went to normal, no snoring, no holding breath.
Canceled sleep study. That was four years ago, now I don’t even need the blood pressure meds.
I’m just telling you, not explining it.
I heard of one procedure where they insert plastic strips into the soft palate to stiffen it. The procedures where they either cook or freeze the tissue seem kinda silly and possibly risky to me.
I appreciate the tip. After hitting so many walls in a particular endeavor I tend to stop trying. Bad habit.
I haven't tried that and don't think I could go for it but I have learned to cock my head back on my pillow (I sleep on my side) which makes it difficult for the throat tissue to collapse and block the esophagus. It definitely reduces both snoring and the apnea.
You forgot to add the “cheap shot at the overweight” alert.
No thanks! I’m waiting for that nifty anti-snore pillow that a German guy invented.
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