Sleep Specialist Dr. Gerald Suh Reports that Multilevel Procedures Improve Results
Study and results
"The site of obstruction causing sleep apnea is different from patient to patient," says Dr. Suh. "There may be blockage at the nose, the palate or the base of the tongue. In many patients, there is more than one level of obstruction. The basic surgical procedure is to remove or trim tissue at one or more of these locations." For many apnea sufferers, and not just those who are obese, the tongue is a major obstructive factor and surgical procedures have been developed to reduce the size of the tongue at its base.
In Dr. Suh's study, fifty patients with moderate to severe apnea, all of whom had blockage at the level of the tongue, underwent surgery to address their tongue collapse. Patients underwent procedures that remove tissue at the back of the tongue (midline glossectomy) and the tonsil at the base of the tongue (lingual tonsillectomy). The study evaluated variables such as age, sex, body mass index and characteristics of the tongue and tonsils for their effect on outcome. The only factors that turned out to be associated with a significant difference in success rate were the relative size and position of the tongue and the severity of the apnea. With a successful outcome defined as more than a 50% reduction in apnea occurrence and a final AHI (apnea-hypopnea index) less than 20, which typically indicates a lower risk of morbidity, the overall success rate was 56% and some sub-groups achieved success rates as high as 75%.
"This study yielded important information that helps us understand the factors that contribute to apnea in each patient and determine which specific surgical procedures offer the best opportunity for a successful outcome for that individual," says Dr. Suh. "There is no 'one-size-fits-all' treatment for apnea. We have a wide array of techniques available and studies like this one help us make the best match between patient and procedure."
Background on Obstructive Sleep Apnea
When we sleep, all the muscles in the body relax. In people who are susceptible to apnea, the relaxed throat and tongue muscles cause soft tissues to block the airway. With air unable to get to the lungs, the oxygen level in the blood drops and when the amount of oxygen reaching the brain decreases, the brain signals the body to wake up and take a breath. The cessation of breathing generally lasts from ten to thirty seconds and in those with severe apnea may occur hundreds of times a night. Narrowing of the airway often causes snoring although not all snoring is caused by apnea. Sleep apnea can affect anyone but is more common in men than in women and while it is most prevalent in those who are overweight, there are also anatomical features associated with apnea, including a narrow throat and thick neck.
"Lifestyle changes may bring relief to apnea sufferers," says Dr. Suh. "We recommend weight loss, avoiding sleeping on the back, eliminating alcohol and other sedating medications that induce muscle relaxation, and avoiding smoking, which increases the risk of apnea by aggravating swelling in the upper airway." One standard treatment for apnea is a continuous positive airway pressure (CPAP) device - a mask that fits over the nose and/or mouth and gently blows air into the airway to help keep it open during sleep. Other options include dental appliances worn at night that reposition the lower jaw and tongue. But for patients with more severe apnea and those for whom conservative measures are ineffective or not tolerated, surgery may be necessary to remove tissues that block the airway.
Dr. Suh concludes: "Curing obstructive sleep apnea or significantly reducing its symptoms will dramatically improve overall health and reduce the risk of heart disease and stroke while improving quality of life by allowing patients to sleep restfully."
Dr. Gerald Suh is board certified in otolaryngology and sleep medicine and is a fellow of the American Academy of Sleep Medicine. He is a leader in treating sleep disordered breathing. http://www.entandallergy.com/
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