Surgery is one treatment option for people who have obstructive sleep apnea. Procedures tend to be “site-specific;” they will seek to eliminate the cause of the obstruction.The challenge is finding the right site for surgery. Problem areas related to OSA include the tonsils, tongue, soft palate, throat, jaw and nose.
As a result, surgery isn’t a “one size fits all” treatment. In fact, the AASM’s clinical guidelines list more than 20 common surgical procedures for OSA.
Yesterday the Baylor College of Medicine reported that one way to address this challenge is to use an “endoscope;” this is a small flexible device with a camera on the end.
Doctors at the BCM are using it to help identify the cause of obstructions that happen during sleep apnea. They insert the endoscope into the back of the nose to view the throat while the patient is sedated and sleeps.
The camera gives them a front-row seat when an episode of OSA occurs. By finding the cause of the problem, they can develop a more precise treatment plan. This helps prevent unnecessary surgery.
The AASM reports that CPAP therapy is the treatment of choice for all severity levels of OSA. An oral appliance and surgery are alternative treatment options that may help some people with sleep apnea.
The AASM clinical guidelines report that “maxillary and mandibular advancement” is one surgical procedure that is often effective. Cuts are made into the bones of the upper and lower jaws. The jaws are pulled forward to enlarge the entire upper airway.
Most other sleep apnea surgeries will rarely cure OSA; you may need to continue with another treatment such as CPAP. But surgery may help reduce symptoms and improve quality of life.
Positive results also may not be permanent; symptoms may reappear at a later time after surgery.
ENTs routinely do this in their offices but usually with the patient awake and sitting up. Most don't do the same thing with the patient lying flat on their backs, which can give you a lot more useful information without having to take the patient to the operating room and give general anesthesia.
ReplyDeleteIn general, patients have multiple areas of obstruction, with the tongue base being the most common culprit. This is why single level surgery doesn't work, most of the time.
The concept of sleep endoscopy isn't new - it was written about years ago. In theory, as your muscles relax in deep sleep, you should be able to see the area of obstruction. In theory, it sounded great, so I did a little experiment. Years ago when the original papers came out, I decided to perform sleep endoscopy on a series of my patients just before sleep apnea surgery, before placing the endotracheal tube. What I saw with the endoscope didn't give me any more information than what I already knew, and if didn't change my plan whatsoever.
A good exam in the office (sitting up and lying down) is all you need. Plus, while they're lying down, you can have the patient perform the Mueller's maneuver and thrust his/her lower jaw forward to see how much the posterior airway space opens up. This gives more information about surgical options as well as dental options.