Surgery May Help Treat Sleep Apnea

By Serena Gordon

HealthDay reporter

TUESDAY, September 8, 2020 (HealthDay News) – Continuous positive airway pressure (CPAP) may be the treatment of choice for sleep apnea, but many people struggle to use it every night. For those who cannot tolerate CPAP, new research shows that a combination of surgical techniques can provide relief.

The “multi-level” treatment includes removal of the tonsils, repositioning of the palate (roof of the mouth) and the use of radio frequency to slightly reduce the size of the tongue. In combination, these procedures open the airways and reduce respiratory obstruction, the researchers said.

The study found that the multi-level surgery technique reduced the number of times people stop breathing (apnea events) during sleep and improved daytime sleepiness. People have also reported an improved quality of life after treatment.

“Obstructive sleep apnea is common and many people cannot use major treatments, such as CPAP masks. Surgery is a valid option when an expert surgeon is involved, and it can improve outcomes, ”said study lead author Dr. Stuart MacKay. He is Honorary Clinical Professor of Otolaryngology, Head and Neck Surgery at the University of Wollongong, Australia.

Researchers said that nearly a billion people worldwide suffer from sleep apnea. The airways become blocked during sleep, and as a result people stop breathing for short periods of time, several times during the night. People with sleep apnea have a higher risk of daytime sleepiness, road accidents, heart disease, and strokes.

CPAP does a good job of keeping your airways open while you sleep, but the treatment – including a mask and a long tube – can be hard to get used to. The study authors said that only about half of people with sleep apnea tried CPAP.

For the new study, researchers recruited 102 overweight or obese people with sleep apnea from six clinical centers in Australia, who were on average in their 40s. The aim was to see if the surgery could help adults with moderate or severe obstructive sleep apnea who could not tolerate or adhere to CPAP machines.

Half of the volunteers were randomly assigned to receive sleep apnea surgery, while the remaining 51 continued with medical treatment. Medical management included encouraging weight loss, drinking less alcohol, changing sleeping posture, and treating nasal obstructions by a doctor.

Continued

MacKay said the multi-level surgical technique is widely available in many parts of the world. For the patients in this study, the surgeries were performed by seven experienced surgeons.

Six months after the surgeries, the volunteers in the surgery group had an approximately 27% decrease in the number of apnea events at night. Those undergoing medical treatment only had a 10% decrease.

Those in the surgical group also experienced major improvements in levels of snoring and daytime sleepiness, as well as an improvement in quality of life.

As with any surgery, there are risks.

“The main risks of pain and bleeding are limited to two weeks after surgery. Bleeding occurs in about one in 25 patients. Long-term risks related to taste disturbances, tingling sensation in throat, dysfunction of swallowing are very rare, although they occur transiently in some, ”said MacKay.

Dr. Steven Feinsilver is director of the Center for Sleep Medicine at Lenox Hill Hospital in New York. He said: “Sleep apnea is a very common disease, about as common as diabetes, and similar to diabetes, it is associated with an increased risk of cardiovascular events, such as strokes and heart disease. heart disease.

He added that “CPAP works, but is difficult treatment.”

Feinsilver said surgery that could provide a permanent cure has long been the focus of treatment.

“This study shows that relatively minor surgery, performed in a standardized fashion by skilled surgeons, can significantly improve sleep apnea compared to ‘medical treatment’ (essentially no treatment),” he said. declared.

But he noted that even though people reported improvement, their nighttime breathing had not returned to normal range.

“This is certainly a major improvement, but it is still unclear whether the results (such as cardiovascular risk) will be significantly affected,” Feinsilver said. Further, he suggested that this multi-level surgery may only be an option for a selected group of patients.

The report was published online on September 4 in the Journal of the American Medical Association.

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Sources

SOURCES: Stuart MacKay, MD, honorary clinical professor, otolaryngology, head and neck surgery, University of Wollongong, Australia; Steven Feinsilver, MD, director, Center for Sleep Medicine, Lenox Hill Hospital, New York City;Journal of the American Medical Association, September 4, 2020, online



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