Surgery Is An Option For Some Patients Hoping To Get A Good Night's Rest
10/09/09 Portland, Ore.
An OHSU researcher demonstrates that a common surgical procedure is an effective treatment for sleep apnea for some patients
According to research recently published by an Oregon Health & Science University scientist, a form of surgery called uvopalatopharyngoplasty is effective for treating certain patients who suffer from sleep apnea, one of the most common sleep disorders. The research, conducted in collaboration with scientists at the Mayo Clinic, is published in the September issue of the Mayo Clinic Proceedings.
Sleep apnea is a common disorder in which the tissues at the back of the throat temporarily collapse during sleep. This causes breathing to repeatedly stop and start during the night and often leads to poor-quality sleep and daytime drowsiness. It is estimated that approximately 4 percent of men and 2 percent of women suffer from sleep apnea. In many cases, sleep apnea patients are prescribed a continuous positive airway pressure machine, or CPAP. The machine counters the effects of sleep apnea by forcing the airway to remain open by blowing air through the throat tissues via a facemask.
"The CPAP device can be an effective form of treatment," explained Akram Khan, M.D., an assistant professor of pulmonary and critical care medicine in the OHSU School of Medicine. "However, many patients report they have trouble falling asleep while wearing the facemask or they take the device off after only a few hours of sleep. This latest research helps us identify the patients who are the best candidates for surgery as an alternative to a CPAP. Specifically, we were able to identify patients whose sleep apnea would likely be greatly diminished or resolved by receiving uvopalatopharyngoplasty surgery."
The procedure involves a tonsillectomy along with additional surgery to the palate and uvula. This is done to diminish the constriction of the throat tissues during sleep.
By observing the results of sleep studies for 63 patients several weeks pre and post surgery at the Mayo Clinic, Khan and his colleagues found there are certain patient characteristics that can increase the likelihood of a successful surgical outcome. For instance, patients who are young and have a body mass index (BMI) in the normal to mildly obese range are more likely to have a successful outcome.
The research also suggests that surgical candidates with the greatest likelihood of success would have a moderate level of breathing stoppages per hour - referred to as the apnea-hypopnea (AHI) index. They suggest that a patient with an AHI range of 30 to 35 episodes per hour would be the best candidates for surgery.
"We believe that for a certain segment of sleep apnea patients, this research demonstrates that surgery is a viable alternative to CPAP," added Khan. This is important information for physicians as they discuss possible sleep apnea therapies with their patients."