Discussions around the subject of a surgical option for the treatment of obstructive sleep apnea are frequently passionate. One need only visit the ASAA's online support group to see the verbal fists fly over whether it is a good idea or an idea that is desperately wrong.
The most common surgical procedure for treating OSA is uvulopalatopharyngoplasty or UPPP for short. Developed in 1981 by Dr. Fujita (the same year CPAP was first described) as an alternative to what was the only treatment for sleep apnea a tracheotomy. UPPP involves removing a lot of tissue from around the opening to the upper airway. This procedure is often done in conjunction with others to improve air flow through the nose.
The success of this procedure is reported to be between 16% and 83%, depending on how you define success. Some see success or cure after surgery as a 50% reduction in the Apnea Hypopnea Index (AHI) and others say a 50% reduction with an AHI less than 20. Though an AHI in this range can still considered moderate and detrimental to health.
The medical literature has been recently had several studies looking at the efficacy of the UPPP option for sleep apnea. An article published in September issue of the Mayo Clinic Proceedings provides results of a retrospective study where lab sleep studies were reviewed on 63 UPPP patients pre and post (six months) surgery. The objective of study was to determine if there was improvement in the AHI and whether that improvement was specific to any patient type.
Quoting from the results section of the abstract... "Patients who attained an AHI of 5 or less were younger, had lower Body Mass Indexes (BMI) and had less severe OSA. Of the patients with a post-UPPP AHI greater than 5 received continuous positive airway pressure, with a mean reduction in pressure of 1.4 cm H2O."
The take-away for me from this study and from others I have seen recently is that surgery has a place in the treatment options of obstructive sleep apnea. It can be very effective in *some* cases.
But that said, in my opinion, for surgery to be appropriately more main stream the surgeon must have a way of identifying/screening the candidates for whom this invasive procedure will benefit prior to surgery. Because once it is done, there is no going back.