Surgery as an option?

[sleepawake]

I am a new CPAP user (1 week in and going well) but I keep having this circular debate with my wife.

Wife: So, you will have to use this mask the rest of your life?
Me: Yep.
Wife: Why don't you get a surgery - my brother and your cousin both did?
Me: I don't like the idea of someone cutting my throat. Besides, it wasn't even presented to me as an option, there must be a good reason.
Lather, rinse, repeat.

Ok, so here's the question - Why isn't surgery an option instead of a lifetime of masks and machines?

[advance apologies if this has been discussed a million times, I couldn't find a thread that nailed the topic]

Cheers

[GuyK]

As part of my treatment, I was referred to an ENT surgeon for a consult. In fact, he not only did an exam but insisted on seeing copies of my PSG (and he gave me his interpretation of what he read). I was quite surprised to find out that he is the first ever surgeon I visited that recommended something other than surgery first, and he talked about a prior visit I had to an ENT surgeon where septoplasty was recommended.

So, in my case -- this ENT surgeon said that more often than not, CPAP therapy is a more effective treatment than a surgical solution (I have to stress: this is what he said about my case, not all cases). He said he could do something surgically (including the septoplasty), but he said that there would be no way to know up front that would take care of the problem for good. So he recommended starting with CPAP and taking it from there.

[Wulfman]

No, only about a half-million.

WHICH "surgery" would you (or your wife) be talking about?

If it's UPPP, go up to the Search function and type in "UPPP" and see how many hundred results come up.
If that's the one, the odds are good that after surgery, you would still need XPAP therapy at a much higher pressure.

If it's turbinate or septum surgery, it may help with breathing, but you would probably still need XPAP therapy.

If it's weight-loss surgery.......consider the fact that it was more than likely that the sleep apnea CAUSED the weight gain.

Same story with other "surgeries". It's a very rare case that Obstructive Sleep Apnea is eliminated.


Den

[packitin]

deleted

[jnk]

A few years old, but still, I think, good stuff on the subject:

http://www.umm.edu/patiented/articles/w ... 065_10.htm

On UPPP for example, it says:

"Success rates for sleep apnea surgery are rarely higher than 65% and often deteriorate with time, averaging about 50% or less over the long term. . . . Uvulopalatopharyngoplasty is among the most painful treatments for sleep apnea, and recovery takes several weeks. . . . The procedure also has a number of potentially serious complications:

Infection. In one study this complication was so common that 40% of patients needed another operation because of it. Preventive antibiotics administered an hour before surgery can help reduce this risk.

Impaired function in the soft palate and muscles of the throat.

Mucus in the throat.

Changes in voice frequency.

Swallowing problems.

Regurgitation of fluids through the nose or mouth.

Impaired sense of smell.

Failure and recurrence of apnea. In such cases, CPAP is often less effective afterward, although one study found that oral appliances may still help.

In one review of studies, 20% of patients who had UPPP required tracheostomy afterward.

--Review Date: 7/19/2006 / Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

This article is only a year old: http://www.medicalnewstoday.com/articles/92980.php

Under the title "Surgery Has No Clear Benefit For Sleep Apnea," it says:

Surgery should not be the first treatment for a patient who suffers from obstructive sleep apnea . . . One of seven randomized trials showed that surgery had very limited impact on symptoms. Even where quality of life showed some improvements, hardly any showed that this improvement lasted more than one or two years. . . . A review of 48 studies showed that 62% of patients who had undergone surgery for obstructive sleep apnea suffered persistent adverse effects, including difficulty in swallowing, voice changes, smell and taste disturbances, and dry throat. . . . As the evidence of a clear benefit from surgery is lacking, plus the risk of adverse side effects (from surgery), guidelines recommend CPAP as the first line of treatment. . . . Information about the inconsistent results of surgery, plus the potential side effects, should be provided to the patient.

On the other hand, surgery to correct true abnormalities of the nasal passages makes more sense to me. Those surgeries can actually make your PAP therapy more effective, I understand.

[sleepawake]

Thank you all for the replies - this is exactly what I was looking for.

I appreciate everyone's patience as I did not even understand that there are multiple surgery types (nor did I have any luck searching the archives).

Great forum!

[Goofproof]

Pain or Fresh Air under pressure, A no brainer, I'll take air. Jim

[GaryGarland]

I went in to the doctor all but begging for surgery and asking for it. the sleep lab had warned me it's only successful about 70% of the time, and without weight loss the fatty deposits (or tissues?) can grow back (or something like that). my buddy had the surgery, sang the praises, and sold me on it. i went to his doctor, and right now the doc feels i'm not a great surgical candidate (prolapsed tongue). and he kept gently pulling out his BMI pamphlet showing i'm roughly, i think, 36%, in the blue range, and he wants me far to the left in the white range) - i had really hoped a zap with a laser, a week off, and i'd be fine, and i figured the doc would be thrilled and make far more with the surgery, but (unfortunately, i guess) he has ethics so i'm on the machine, at least for the foreseeable future.
For what it's worth, i was also told if your neck size is more than 17 inches you probably have obstructive apnea - my neck hasn't been 17 in probably 20 years!!!!!
last bit - i was warned by my buddy that the docs make a lot more for the surgery as outpatient than in the hospital, and that the recovery was rough and he felt screwed, that he should have insisted on doing it in the hospital. he switched health plans so didn't/couldn't use the doc he recommended to me for the surgery - from that i'd personally insist on it done in the hospital (for recovery) versus the doc's office.

[georgepds]

I am a new CPAP user (1 week in and going well) but I keep having this circular debate with my wife.
....
Lather, rinse, repeat....

So, being a married man myself, I'm wondering how this intimate discussion differs from any other.

[echo]

sleepawake, do I also detect an undercurrent of .... annoyance ... from your wife? Which is totally to be expected, her sleep is being affected by this too (positively or negatively). Maybe the mask/machine noise bothers her, or the air from the mask, or the clinincal look, or ..... This might be a good opportunity to discuss how she feels about it too. (or maybe I'm just reading too much into it, lol!)

good luck in whatever you decide (but IMHO there's a reason the UPPP is not as popular as lasik surgery!)

[DreamStalker]

Why not just take a pill for OSA ... I hear the placebo effect works just as good as surgery

As for the wife ... maybe she can be surgically removed

Good luck with whatever you decide to do

[nickerjo]

I was in the same boat about 15 years ago. Didn't like the CPAP so opted for the UPPP. It was just like my doctor described it. Drinking gasoline and lighting a match. Made severe strep seem like a picnic. Also I had complications and started severe bleeding a week after the procedure and had to go back to the operating room.

The procedure helped but did not "fix" my apnea - so I have been back on CPAP for the last 7 years. From what I remember - the "cured" rated is fairly small but the "helped" rate is where the majority fall after undergoing the procedure.

jn

[roster]

Anyone want to try to help this butchered guy:

http://sleepnewsblog.com/2693/more-most ... eep-apnea/

mr_landlord79107 asked: I had a UPPP surgery to help with my sleep apnea (CPAP machine-titration 19), it wasn’t effective. I would like to know what are other more aggressive options to help regulate my sleep apnea.

More aggressive than UPPP? Mr. Landlord is one tough guy!

Tracheotomy?

[Snoredog]

I am a new CPAP user (1 week in and going well) but I keep having this circular debate with my wife.

Wife: So, you will have to use this mask the rest of your life?
Me: Yep.
Wife: Why don't you get a surgery - my brother and your cousin both did?
Me: I don't like the idea of someone cutting my throat. Besides, it wasn't even presented to me as an option, there must be a good reason.
Lather, rinse, repeat.

Ok, so here's the question - Why isn't surgery an option instead of a lifetime of masks and machines?

[advance apologies if this has been discussed a million times, I couldn't find a thread that nailed the topic]

Cheers

Because trimming your soft palate, removing your Uvula and tonsils don't prevent the tongue from falling into the back of the throat (cause of most obstructive apnea).

Follow up PSG's prove that. So the next time you are at the ENT discussing how UPPP surgery will solve your OSA problem ask this simple question:

Will the UPPP surgery prevent my tongue from falling into the back of the throat?

Fact is, all that surgery does is make a bigger hole for your tongue to land in. Then it also dooms you from eating Peanut Butter sandwiches with the Uvula gone, your buggers will resemble peanut butter. Since on CPAP the soft palate needs to seal against the base of the tongue during therapy to prevent the CPAP pressure from escaping out the mouth, you are stuck with using a Full Face mask for the rest of your days.

Test it yourself:

1. Get a hand-held mirror and flashlight. Lay down, put on your mask, turn on the machine.
2. Keep your tongue planted into your hard palate, mouth/mandible closed. Get the mirror and flashlight,
3. You should find that CPAP pressure does not escape from the lips, now slowly begin opening the mouth observing
what the tongue is doing, allow the lips to part, air should still not be escaping, allow the mandible to drop
slightly, if you observe with the flashlight you should see the soft palate sealing against the base of the tongue,
you may even see the Uvula pointed outward in the center of the groove of the tongue. That is where your
CPAP therapy is making the seal to prevent the pressure from escaping out the mouth. You should be
able to open your mouth where the lips part up to 3/4" or so before that seal is broken.

Have UPPP surgery and that soft palate no longer makes that seal, you will never be able to perform
the above after surgery, nor will you be able to use a nasal mask which provides the best therapy
over a Full Face mask. Your only other option is to tape and your mouth will still fill with air and
cheeks will puff out.

The soft palate IS needed and used, most ENT just don't know what for. That Uvula comes in handy eating
a peanut butter sandwich. Some people need their tonsils removed, but I wouldn't let them touch
my soft palate or Uvula.

Rarely does UPPP even reduce the number of events seen much less cure it. UPPP might reduce the snoring,
but it doesn't prevent the apnea caused by the tongue being sucked into the back of the throat.

Watch this video, pay special attention to "what" the obstruction is, also observe what the soft palate is doing,
but even more important what the tongue's role is with an apnea:
http://www.resmed.com/en-us/patients/ab ... 40x380.swf

[GaryGarland]

snoredog, great post - you just clarified what the doc said to me about my prolapsed tongue (which i thought was unique) and why i don't seem to be a surgical candidate - now it seems that's the most common aspect of osa (at least from what i just saw on your video)
thanks!