Napoli Seeks Surgery For Sleep Disorder

Mike Napoli escaped surgery after injuries at various points this season to a finger, a toe, a knee and his back.The Boston Red Sox first baseman won't be so fortunate with regard to his sleep disorder.

I've been dealing with sleep apnea for a long time, my whole career," Napoli told WEEI.com in a text message. "I've tried numerous things and none of them worked. Dental mouth piece, CPAP machine, medicines ... It's just gotten to the point where I have to get this done."

To read the rest, go to

http://espn.go.com/boston/mlb/story/_/i ... leep-apnea

49er

Maybe Napoli should seek the advice of some of the members of CPAPtalk before pulling the trigger on the surgery. From what I've read there doesn't seem to be a lot of long-term gain.

Sir NoddinOff wrote:Maybe Napoli should seek the advice of some of the members of CPAPtalk before pulling the trigger on the surgery. From what I've read there doesn't seem to be a lot of long-term gain.

I knew someone was going to make that suggestion. I would think that being a professional athlete, he had access to top medical care but of course, you can't assume anything.

I am curious as to where you obtained your information. According to this site, http://www.medscape.com/viewarticle/501708_3,

MMA is the most effective sleep apnea surgical procedure currently available. The success rate is usually between 75 and 100%[20,31,32,37,38] with a long-term success approaching 90%.[39,40] Although MMA is considered a fairly invasive procedure, the associated surgical risks are low, including bleeding, infection, malocclusion, and permanent numbness. In general, patient perceptions of surgical outcome have been very favorable.[37]

Now, as a disclaimer, I did not read the additional references that are provided. Sorry, too exhausted from hassling with my insurance company.

Anyway, I thought for older people, I saw information that the success rate isn't as great as what is being quoted on the medscape site. So maybe since this guy is in his early 30s, he has a better chance of success.

No matter what, hopefully, everything turns out well for him.

49er

Anyway, I thought for older people, I saw information that the success rate isn't as great as what is being quoted on the medscape site. So maybe since this guy is in his early 30s, he has a better chance of success.

The key here, is what defines "success"? It's not discussed in the article, but typically "success" for such procedures is a 50% reduction in untreated AHI and/or a 50% reduction in pressure needed to keep the airway open. So, for example, my untreated AHI is 73--a 50% reduction would be 36, and I'd STILL need CPAP. A 50% reduction in my pressure of 15 would mean 7 cm/H2O. Still on CPAP. So I'd undergo a potentially dangerous and most certainly painful procedure with a limited chance of not improving things much, and have lifelong side effects (people report issues swallowing). No thanks.

The way we (CPAP users) think of success is a "cure" so that CPAP is no longer needed. That's not usually the outcome.

Thanks Jan. Didn't find too much more information than what has been discussed but here is something additional:

http://ihatecpap.blogspot.com/2010_09_01_archive.html (Yes, I do realize the irony of posting this link:))

The reported efficacy of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) is uncertain. We performed a meta-analysis and systematic review to estimate the clinical efficacy and safety of MMA in treating OSA. We searched Medline and bibliographies of retrieved articles, with no language restriction. We used meta-analytic methods to pool surgical outcomes. Fifty-three reports describing 22 unique patient populations (627 adults with OSA) met inclusion criteria. Additionally, 27 reports provided individual data on 320 OSA subjects. The mean apnea-hypopnea index (AHI) decreased from 63.9/h to 9.5/h (p<0.001) following surgery. Using a random-effects model, the pooled surgical success and cure (AHI <5) rates were 86.0% and 43.2%, respectively.

Still don't what they are referring to as a success rate but as everyone can see, the cure rate is 43.2%. Hmm, in light of that, if I couldn't use the pap machine, I would probably be looking at dental appliances vs. before resorting to surgery since the worse true success rate statistic is around 40% for the severe range. Mild is mostly 75% and moderate is mostly 60%.

But even if someone is only able to get their AHI reduced by 50%, if they have tried everything else and truly made an effort to make things work, it still is better than doing nothing. And if I were going to have any surgeries that involve the anatomy, I would do a sleep endoscopy to make the procedure I was considering was addressing the right area as that increases the true success rate.

49er

Janknitz wrote:

Anyway, I thought for older people, I saw information that the success rate isn't as great as what is being quoted on the medscape site. So maybe since this guy is in his early 30s, he has a better chance of success.

The key here, is what defines "success"? It's not discussed in the article, but typically "success" for such procedures is a 50% reduction in untreated AHI and/or a 50% reduction in pressure needed to keep the airway open. So, for example, my untreated AHI is 73--a 50% reduction would be 36, and I'd STILL need CPAP. A 50% reduction in my pressure of 15 would mean 7 cm/H2O. Still on CPAP. So I'd undergo a potentially dangerous and most certainly painful procedure with a limited chance of not improving things much, and have lifelong side effects (people report issues swallowing). No thanks.

The way we (CPAP users) think of success is a "cure" so that CPAP is no longer needed. That's not usually the outcome.

Sir NoddinOff wrote:Maybe Napoli should seek the advice of some of the members of CPAPtalk before pulling the trigger on the surgery. From what I've read there doesn't seem to be a lot of long-term gain.

Janknitz wrote:

Anyway, I thought for older people, I saw information that the success rate isn't as great as what is being quoted on the medscape site. So maybe since this guy is in his early 30s, he has a better chance of success.

The key here, is what defines "success"? It's not discussed in the article, but typically "success" for such procedures is a 50% reduction in untreated AHI and/or a 50% reduction in pressure needed to keep the airway open. So, for example, my untreated AHI is 73--a 50% reduction would be 36, and I'd STILL need CPAP. A 50% reduction in my pressure of 15 would mean 7 cm/H2O. Still on CPAP. So I'd undergo a potentially dangerous and most certainly painful procedure with a limited chance of not improving things much, and have lifelong side effects (people report issues swallowing). No thanks.

The way we (CPAP users) think of success is a "cure" so that CPAP is no longer needed. That's not usually the outcome.

Looks like anyone can post bad information on here and nobody checks them.

According to AADSM success rate of MMA ranges from 94 to 100% with success defined as AHI<5 or normal sleep breathing.

This is a major surgery and patient selection is done carefully.