Treatment with surgery or an oral appliance that adjusts the jaw is associated with improvements in obstructive sleep apnea, a condition caused by blocked upper airways in which patients periodically stop breathing during sleep, according to two reports in the May 2009 issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.
Sleep apnea is most commonly treated with continuous positive airway pressure (CPAP) therapy, according to background information in one of the articles. Individuals undergoing CPAP therapy wear a mask at night connected to a machine that increases air pressure in the throat, preventing the airway from closing.
"Although it is a safe and effective therapy, it has several drawbacks including discomfort or skin irritation from the mask, dry or stuffy nose and eye irritation," the authors write. "Such complications result in compliance rates of between 50 percent and 70 percent, even in patients with successful amelioration of obstructive sleep apnea syndrome symptoms by using CPAP."
"Patients with obstructive sleep apnea who cannot tolerate or refuse CPAP therapy may be considered for surgical treatment," write Neville Patrick Shine, F.R.C.S. (O.R.L.-H.N.S.), of St. Johns Hospital, Edinburgh, Scotland, and Richard Hamilton Lewis, F.R.A.C.S., of Royal Perth Hospital, Perth, Australia.
Drs. Shine and Lewis reviewed the medical records of 60 patients (55 men and five women, average age 47.5) undergoing surgery to treat obstructive sleep apnea between 2002 and 2006. The procedure, transpalatal advancement pharyngoplasty, aims to address the airway obstruction and create a larger space in the area behind the roof of the mouth. All participants underwent sleep testing before and after surgery.
As measured by the number of sleep disturbances and arterial oxygen saturation (the amount of oxygen in blood flowing through the arteries, which decreases in patients with obstructive sleep apnea), surgery was considered successful in 38 of the 60 patients (63 percent). Sleep apnea was completely cured in 21 patients (35 percent).
No associations were found between preoperative characteristics — including demographic, historical and clinical variables such as disease severity or obesity — and surgical outcome, suggesting that it may be difficult to predict which patients will respond well to the procedure.
"To our knowledge, this is the largest series reported to date regarding the transpalatal advancement pharyngoplasty procedure," the authors conclude. "It should be considered in patients in whom conservative management has failed and who are willing to undergo surgery to improve the retropalatal airway."
In another article, Chul Hee Lee, M.D., and colleagues at Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, evaluated 50 Korean patients (46 men and four women, average age 50.2) who received an oral device to treat obstructive sleep apnea between 2005 and 2007.
The mandibular advancement device prevents airway obstruction by moving the lower jaw forward. Patients underwent sleep testing by polysomnography before and at least three months after receiving the device, completed questionnaires about sleep quality, and sleepiness and had several measurements of their tongue and throat areas taken and analyzed.
As defined by the number of episodes of shallow or stopped breathing per night, the device was considered successful in 37 of 50 patients (74 percent). This included three of seven patients with mild cases of obstructive sleep apnea (43 percent), 22 of 27 with moderate cases (82 percent) and 12 of 16 with severe cases (75 percent). No differences were seen between patients who did and did not respond successfully to treatment with regards to demographic data or data gathered during sleep testing.
"In conclusion, the mandibular advancement device is a simple, non-invasive, easy-to-manufacture and easy-to-use device and showed good treatment outcome in nocturnal respiratory function and sleep quality in Korean patients with obstructive sleep apnea," the authors write.
"Even in patients with severe obstructive sleep apnea, mandibular advancement device application showed a good success rate,” the authors wrote, adding that “mandibular advancement device application can be used as a good alternative option in patients with obstructive sleep apnea, without patient selection, and could be used in patients with severe obstructive sleep apnea," the authors concluded.
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/Health — xPAP Compliance/surgery-oral-devices-may-help-after-cpap-use-failur/2009-05-27.1016
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{ 2 comments… read them below or add one }
The problem? Doctors don’t listen to dentists and there is little communication between the two fields on apnea. Further, HMOs will not deal with many medical issues that require dental intervention.
Until the communication commences, those of us with apnea are given few alternatives outside of CPAP therapy or throat surgery. Even dental insurance does not cover apnea.
Allowed tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>@CPAP Granny:
You’ve hit the nail on the head for one of the biggest issues in health care today, but only one of several nails.
Doctors don’t listen to dentists very often, as many doctors, it seems, believe they have total rights over all parts of the body, though they will stand aside for a dentist to to oral care or a podiatrist to do foot care.
When it comes to sleep apnea, it seems many physicians believe only they — not any other allied health professional — as the understanding needed to treat apnea, but that is slowly changing. With the TAP, for example, some physicians are beginning to see it as a beneficial way to treat apnea, but that isn’t a widespread belief.
As for treating sleep apnea, there are only a methods to treat it — that are tested and proven — and many that are tested and shown to have little to no effect, and then there is the Draconian UPPP which some physicians recommend and use.
The field of sleep medicine, as a discipline, is just getting out of its infancy stage and starting its toddler stage. It’s at the same point, approximately, as where diabetes was back in the late 1960s and early 1970s. It’s going to take time to get things done, but also time to do more research to find better or alternative ways to treat apnea.
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