Say Farewell to Daytime Fatigue with Surgery for Sleep Apnea

Treatment for obstructive sleep apnea can greatly improve your quality of life, the Sleep Education Blog often reports. A new study from researchers at Henry Ford Hospital shows surgery, like CPAP, can make you feel less sleepy during the daytime.

The study examined the effectiveness of three surgical interventions for sleep disordered breathing – removing excess tissue in the back of the throat, removing the tonsils and using radiofrequency waves to destroy tissue at the base of the tongue.

A group of 40 patients with mild to severe obstructive sleep apnea participated in the study. Before surgery, the patients completed the Epworth Sleepiness Test, a questionnaire that measures daytime sleepiness during various activities. All of the patients had an Epworth Sleepiness Score (ESS) of 10 or higher, meaning they were very sleepy during the day.

After surgery was completed, the patients’ average ESS dropped to 5.5. Nearly all of the patients posted dramatic improvements. Only one patient had no change in score, while two had an increase. Researchers also noted the patients had half as many pauses in breathing while they slept.

Never leave obstructive sleep apnea untreated. It can ruin your quality of life and make you feel constantly tired. Untreated OSA can also lead to other serious health problems, like heart disease or stroke.

Surgery is only one of the effective treatment options for OSA. CPAP, or continuous positive airway pressure, is the mainline treatment for the disorder, however severe. People with less severe OSA cases can also use an oral appliance to prevent the symptoms of OSA.

Photo by Julia Manzerova

Learn About Sleep Apnea Treatments in 2 Minutes

Last week, Stanford University Hospitals and Clinics posted this educational video explaining sleep apnea. In the online video, AASM Past President Clete Kushida explains the top three treatment options:

The three main treatments options are Continuous Positive Airway Pressure (CPAP) , surgery and oral appliance therapy.

If you think you may have sleep apnea book an appointment at your nearest AASM-accredited sleep center.

Gary Kubiak: Sleep Apnea, Surgery & the NFL

Houston Texans head coach Gary Kubiak is receiving surgical treatment for obstructive sleep apnea.

Nose surgery was performed yesterday, reports The Houston Chronicle. In six weeks another procedure will be performed on his throat.

Sleep apnea is a common problem in the NFL. Last year the Sleep Education Blog reported that OSA is common in retired NFL players. The NFL and the NFL Players Association previously began working together to target heart disease and sleep apnea in retired players.

And a 2003 study of 302 NFL players found that they are more likely to have sleep apnea than other men their age. The risk was highest for offensive and defensive linemen.

Although Kubiak is a retired NFL player, he wasn’t a lineman. He was a back-up quarterback for the Denver Broncos from 1983 to 1991. Kubiak threw 14 touchdown passes in limited playing time behind John Elway, a 2004 inductee in the Pro Football Hall of Fame.

And the 48-year-old Kubiak isn’t obese. He is listed at 6 feet, 192 pounds. This gives him a body mass index (BMI) of 26, which means he is slightly overweight.

His case is a good reminder that OSA can occur in men and women of all body types. It also can occur in children.

Excess body weight is the major predisposing factor for obstructive sleep apnea. But OSA also occurs in people who maintain a healthy weight. A study presented at SLEEP 2009 found a high rate of sleep apnea in non-obese adults.

The AASM reports that CPAP therapy is the treatment of choice for all severity levels of OSA. A surgical procedure is an alternative treatment option for some people with sleep apnea.

It may be required to correct a physical abnormality. It also may be performed if you are unable to have success with CPAP or an oral appliance.

Surgical procedures tend to be “site-specific;” they will seek to eliminate the cause of the obstruction. Problem areas related to OSA include the tonsils, tongue, soft palate, throat, jaw and nose.

In Kubiak’s case, septoplasty may have been performed on his nose to straighten a bent septum. Or he may have had turbinate reduction to reduce or remove large turbinates and polyps from the nasal passage.

His upcoming surgery may involve the removal of soft tissue from the throat. This tissue can collapse and block the airway during sleep.

Are you at risk for sleep apnea? STOP and find out. You also can answer these questions on SleepEducation.com to learn more about your risk. Get help for sleep apnea at an AASM-accredited sleep center near you.

Read more about OSA and surgery.

Image by Brit

Sleep Apnea & Surgery: Caught on Camera

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.

Get help for sleep apnea at an AASM-accredited sleep center near you.

Sleep Apnea Surgery: Is UPPP for You?

Are some people with obstructive sleep apnea more likely to benefit from surgery than others?

A new study involved 63 people with OSA. They had an average age of 42 years, and 81 percent were men. Their average body mass index was 35; a BMI of 30 or higher is considered “obese.”

Each person underwent “uvulopalatopharyngoplasty.” UPPP involves the removal of soft tissue from the throat; this tissue can collapse and block the airway during sleep. The soft palate is trimmed down in size. The tonsils and uvula may also be removed.

The effectiveness of UPPP was measured after an average of about three months; participants were monitored during an overnight sleep study.

Results show that the surgery eliminated OSA in only 24 percent of participants. These people were younger and less obese. They had an average age of 36 years and an average BMI of 31.

They also had less severe sleep apnea. Before surgery they had an average apnea-hypopnea index of 38 breathing pauses per hour of sleep. The average pre-treatment AHI was almost 70 in people who still had sleep apnea after surgery.

“This latest research helps us identify the patients who are the best candidates for surgery,” lead author Dr. Akram Khan said in a press release.

The AASM reports that CPAP therapy is the treatment of choice for all severity levels of OSA. A surgical procedure is an alternative treatment option for some people with sleep apnea. It may be required to correct a physical abnormality; it also may be performed if you are unable to have success with CPAP or an oral appliance.

There are a variety of surgeries that can help correct a specific problem. Targeted areas include the throat, tonsils, jaw and nose. Surgery may not cure OSA; you may need to continue with another treatment such as CPAP. Positive results also may not be permanent; symptoms may reappear at a later time after surgery.

Get help for sleep apnea at an AASM-accredited sleep center near you.

Sleep Apnea Treatment: What Works Best?

A story today on NPR’s “Morning Edition” discussed treatment options for obstructive sleep apnea and snoring.




What is the best treatment for OSA? In June the AASM released a clinical guideline for the evaluation and treatment of sleep apnea; it was published in the Journal of Clinical Sleep Medicine. Here is a summary of the AASM recommendations:

1. CPAP Therapy
CPAP therapy is the “treatment of choice” for OSA. It is effective for all severity levels of sleep apnea. CPAP should be the first treatment that a doctor offers to someone with OSA.

CPAP stands for “continuous positive airway pressure.” It provides a steady stream of air through a mask that you wear during sleep.

2. Oral Appliance Therapy
An oral appliance is an alternative treatment option for people with mild or moderate OSA; people with severe OSA should be treated with CPAP. Oral appliance therapy also can help a person who has primary snoring.

An oral appliance is a dental mouth piece that you wear during sleep. It fits much like a sports mouth guard or an orthodontic retainer. It either holds the tongue or supports the jaw in a forward position. An oral appliance should be customized to fit you by a dentist who has been trained in dental sleep medicine.

3. Surgery
A surgical procedure is an alternative treatment option for some people with OSA. It may be required to correct a physical abnormality; it also may be performed if you are unable to have success with CPAP or an oral appliance.

There are a variety of surgeries that can help correct a specific problem. Targeted areas include the throat, tonsils, jaw and nose. Surgery may not cure OSA; you may need to continue with another treatment such as CPAP. Positive results also may not be permanent; symptoms may reappear at a later time.

4. Behavioral Strategies
Weight loss is recommended for everyone with OSA who is overweight. But it rarely cures sleep apnea. It should be combined with another treatment. Positional therapy – side sleeping – may help some people with less severe OSA.

A board-certified sleep specialist can determine which treatment option is best for you. Contact an AASM-accredited sleep disorders center for help with sleep apnea.

STOP to Find Out if You Are at Risk for Sleep Apnea

A new study confirms that the "STOP questionnaire" is a useful tool for predicting your risk of obstructive sleep apnea. So what’s your risk?

To find out, answer these four simple, yes or no “STOP” questions:

S: Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)?

T: Do you often feel TIRED, fatigued, or sleepy during daytime?

O: Has anyone OBSERVED you stop breathing during your sleep?

P: Do you have or are you being treated for high blood PRESSURE?

You have a high risk of sleep apnea if you answered “yes” to two or more of these questions. You have a low risk if you answered “yes” to less than two questions.

The questionnaire has an even higher predictive value when you answer four more questions in the “STOP-Bang” version:

B: BMI more than 35 kg/m2?

A: Age over 50 yr old?

N: Neck circumference greater than 40 cm (15.75 in)?

G: Gender male?

You have a high risk of sleep apnea if you answered “yes” to three or more of the eight STOP-Bang questions. You have a low risk if you answered “yes” to less than three questions.

Why is this important? It is estimated that about 80 percent of men and 90 percent of women with moderate to severe sleep apnea are undiagnosed. You could be one of these people.

The STOP-Bang tool was designed for people who are about to undergo surgery. You may have increased complications during surgery if you have undiagnosed sleep apnea.

But it is a useful tool that anyone can use. Yet no screening tool is perfect. And the only way to confirm that you have sleep apnea is with a sleep study. Contact an AASM-accredited sleep center near you for help.

Learn more about your risk for sleep apnea on SleepEducation.com.

Image by Brandi Tressler

Surgery Helps “Boy Who Couldn’t Sleep”

ABC News and Good Morning America report that a risky surgery has helped a 3-year-old boy who was unable to sleep.

Before the surgery Rhett Lamb was awake nearly 24 hours a day. Although his body was exhausted, his mind remained alert.

The sleepless nights caused plenty of trouble. He had mood and behavioral problems. He couldn’t even speak. Overall he was functioning at the level of an 18-month old.

His problems also took a toll on his parents. They were emotionally and physically exhausted. Caring for him around the clock caused them to suffer from sleep deprivation too.

For years his parents struggled to find the source of his problem. Finally a doctor discovered the cause: chiari malformation.

CM occurs when the space at the lower rear of the skull is too small. This puts pressure on the brain and pushes it downward. As a result brain tissue may be forced into the spinal canal.

The surgery appears to have been a success. Rhett shocked his parents when he slept through the night for the first time. They rushed to his room in the morning to make sure he was breathing.

Now that he is sleeping well, Rhett’s development has improved dramatically. For the first time in his life he is interacting and playing with other children.