SURGERIES AND ORAL APPLIANCES FOR SLEEP APNEA

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THE ONLY SLEEP APNEA SURGERIES WITH HIGH SUCCESS RATES ARE:

-TRACHEOSTOMY (TUBE INTO WINDPIPE AT BASE OF NECK):

--The original treatment for severe sleep apnea. It was usually effective but associated with frequent complications (chronic infection, etc.)

-MANDIBULAR/MAXILLARY OSTEOTOMY AND ADVANCEMENT (MMO)

--This procedure has a reported 94-95% success rate and can be an excellent option for some patients. It involves fracturing the mandible (jaw) and maxilla which holds the upper teeth, with use of bone grafts to move both forward. It surprisingly involves less pain than surgeries on the soft palate which have high failure rates, and cosmetic results are often very positive as well--particularly in those patients who have a small, retruded jaw and an "overbite".

--In the past, the MMO was performed after other surgeries on the palate, nasal airway, etc. It now is often performed as an initial procedure and is a valuable addition to our treatments for sleep apnea.

 

OTHER SLEEP APNEA SURGERIES:

-NASAL SURGERIES FOR SLEEP APNEA:

--Sometimes are helpful in a general sense or to improve a patient's ability to use positive airway pressure, but as treatments for sleep apnea, they have only a 5% success rate.

-PALATE SURGERIES (UVULOPALATOPHARYNGOPLASTY, OR UPPP):

--These procedures were originally said to have a 50% success rate, but success was defined in many studies of these surgeries as a 50% drop in the number of apneas per hour. If a patient initially was quitting breathing 100 times per hour, a decrease to 50 times per hour doesn't mean surgery was a success! Also, there is no reliable way to predict which patients will even achieve that much improvement.

--When patients have excessive drops in their blood oxygen levels, the odds of these surgeries adequately restoring their blood oxygen levels to safe levels is only in the range of 18-30% -- and many patients with sleep apnea experience such excessive oxygen drops.

--Also, UPPPs can lose their effectiveness over time. A number of those patients who initially respond to these surgeries relapse within a few years: "sliding backward" toward where they started, such that they have to be reevaluated and more effective treatment instituted if they are to avoid serious complications.

--There are risks associated with anesthesia, particularly in patients who already are experiencing breathing failure when not awake. Furthermore, tissue swelling and packing of the nose, if required, sometimes can aggravate airway closure to make an already bad situation worse. Some complications and a few deaths have been reported.

--It can take some months for healing to be completed and before any improvement (if such occurs at all) is realized. This delay in results can leave people at an ongoing risk of major complications if their sleep apnea was severe.

--UPPP surgeries frequently make patients quieter but not truly adequately better. They are much more effective at reducing snoring than at treating the underlying sleep apnea. Hence, both patients and their bed partners can be lulled into a false sense of security following these surgeries. Both may believe that a cure occurred when it didn't--in which case the patient may even be at continuing risk of heart attack, heart failure and stroke without knowing it!

-LASER SURGERIES ON THE PALATE (LASER-ASSISTED UVULOPALATOPLASTIES; OR "LAUP"s:

--No generally accepted studies have shown them to be of any significant benefit for sleep apnea or other serious breathing disorders in sleep. Thus, the the American Sleep Disorders Association came out with a position paper opposing their use for treating sleep apnea.

--Since LAUP's remove less tissue than standard palate surgeries that have substantial failure rates, there is no reason to expect they would work.

--There is nothing magic about lasers. If a surgery were not likely to work, it wouldn't matter if it were performed with a scalpel, laser or chain saw.

 
-SOMNOPLASTIES (INSERTION OF A PROBE INTO THE PALATE TO INDUCE INTERNAL TISSUE CHANGES):

--A more recent procedure for simple snoring.

--This procedure would be even less likely to improve significant sleep apnea than would laser surgery!

--It is not an accepted treatment for sleep apnea--and there is no reason to think it will become one.

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