Tuesday, February 28, 2006

Somnoplasty for sleep apnea?

I am a [age omitted to protect identity] year old woman with sleep apnea. The following conditions were noted in the medical diagnosis: slightly elongated uvula,
deviated septum. [I] was given the CPAP which I have used for the
past 6 years. It is a nuisance, but it DID give restorative sleep for
about 4 of those years.

CPAP = continuous positive airway pressure, the treatment of choice for obstructive sleep apnea. Why is it the treatment of choice? Because (1) it works 100% of the time, and (2) as a nonsurgical treatment, it carries 0% surgical risk. (Funny how that works!)

The main problem with CPAP is compliance. About 50% of the folks who try CPAP ultimately fail to adapt to it. It is a rather unnatural, cumbersome device. Nevertheless, if you were able to use it for four years, that tells me you are in the 50% who can tolerate CPAP.

I lost about 12% of my overweight (52 lbs.) and the CPAP doc agreed that the dental device alone might do the trick. It worked OK for a while and then I had to return to the CPAP. In
the past 2 years I've experienced episodes of waking with a rapid heavy heart beat.

Are you talking about the device that thrusts your lower jaw forward? If this helped, it suggests your obstruction is at the level of the tongue base rather than the soft palate. Some folks are performing radiofrequency ablation of the tongue base, but you might have a hard time finding someone who is familiar with that procedure. A conventional somnoplasty involves radiofrequency ablation of the soft palate, not the tongue base.

I'm wondering about your math, by the way. If 52 lbs = 12% of your "overweight", this suggests you're over 400 pounds overweight.

An ENT can determine where you are obstructing with a reasonable degree of certainty by examining your airway with a flexible fiberoptic scope. This will help the ENT figure out what sorts of surgical procedures are helpful.

I have PAT, controlled well by medication. I also have abundant torae
in lower jaw . . . and one fair-sized one growing toward the back of the
roof of mouth. I realize you would have to SEE the area to evaluate
the amount of narrowing, but do you think it might be helpful to
investigate the effect of a SOMNOPLASTY on encroaching sleep apnea?
Since my stomach will not retain pain meds (even pain shots cause
vomitting), I dread the thought of the knife-blade surgery and weeks of
pain, etc., etc.

As I indicated above, an appropriate physical exam (including a fiberoptic airway exam) is essential to answering this question. Also critical are the numbers on your sleep study. If your obstructive sleep apnea is mild, somnoplasty might be an option. If your OSA is moderate to severe, somnoplasty is simply not aggressive enough to solve anything.

Would appreciate your description of somnoplasty, and your comments on
whether I should pursue that procedure.

I can describe somnoplasty for you, but I can't give you any advice as to whether you should pursue it. That's for you to discuss with your doctor.

"Somnoplasty" is a proprietary term, but it has come to refer to all radiofrequency soft palate ablation techniques. The doctor anesthetizes your soft palate with multiple local anesthetic injections. Next, he uses an insulated electrode to heat (with electrical current) the muscle of the soft palate and uvula in several different sites. Over time, the heated area scars down, shortening and stiffening the soft palate and uvula. To some degree, this decreases the volume of the tissue, too.

It's a good treatment for snoring, not so hot for OSA. It's well tolerated compared to the older technique, LAUP (laser-assisted uvulopalatoplasty), which is legendary in terms of post-procedure pain. Pain after a somnoplasty usually does not require narcotic pain medications -- Motrin usually suffices. Some of my patients need narcotics, however.

Multiple procedures are necessary. With the equipment I use, most folks require 3 or 4 separate treatments, spaced out about 4 to 6 weeks apart. Some of my patients have needed 6 or more treatments. It's less aggressive than a LAUP, and therefore less painful, but the tradeoff is, you need more separate procedures.

Risks include, but are not limited to, ulceration of the soft palate, swelling of the uvula or soft palate, more pain than you were bargaining for, and failure of the procedure to fix the problem. Your doctor would fill you in on all the other risks, too.

I hope this helps you discuss your options with your doctor.



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At 12:38 PM, Blogger Admin said...

You could try positional therapy for sleep apnea syndrome. There are patients which have fewer apnea episodes when they sleep on their side. If you look at your sleep test result, you should check if you have a difference between sleep positions regarding the number of apnea.

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