tag:blogger.com,1999:blog-10619620.post8863434365270446482..comments2023-10-19T04:20:36.121-04:00Comments on Sleep Apnea Thoughts: Finding a place for the surgical option to treat Obstructive Sleep Apneasleepapneaedhttp://www.blogger.com/profile/00190457246036255560noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-10619620.post-659671756629524752009-10-16T17:26:29.925-04:002009-10-16T17:26:29.925-04:00Ed, you're right in that sleep apnea surgery c...Ed, you're right in that sleep apnea surgery can be an additional option for some people who have tried everything. I'm not surprised that the medical community is still spending valuable resources on studying the usefulness of the UPPP procedure for obstructive sleep apnea. We're too fixated on the notion that the soft palate the root of all the problems, when in fact it's only a small part of the problem. Most people also have tongue base collapse, as well as nasal issues. But science only measures one variable at a time, so these studies will continue.<br /><br />Numerous studies and meta-analyses have shown that a UPPP alone has no better than a 40% "success" rate. The debate over the meaning of success will go on for decades. In very select patients, especially ones with very large tonsils and a relatively small tongue, and not overweight, UPPP has up to an 80% chance of success. Unfortunately, not too many people fit into this category.<br /><br />If you look at the experience at Stanford and numerous other institutions and even in my own experience, addressing the entire upper airway, from the tip of the nose to the voice box, has a much higher chance of success (in the 75 to 80%). If you include skeletal (upper and lower) jaw surgery, the success rates can go as high as 90-95%. <br /><br />CPAP is great when people use it, and there's a lot more that needs to be done in terms of patient education, preparation and long-term follow-up to improve CPAP success rates. But you'll have to agree that the overall long-term "success" rate for CPAP is less than 50%. This includes everyone that's given a CPAP machine to use. Even if people do succeed, initially, there's a sharp drop-off after many years. <br /><br />Clearly, there's no right or wrong answer. There are certain steps that we should take, such as non-surgical before surgical, but in the end, everyone has different needs and wants. We should also take the focus off of a single modality mentality and go to a multimodality frame of mind. Many people benefit from using different combinations of CPAP, oral appliances and surgery. Lifestyle changes, stress reduction, diet and exercise programs are also critical in treating this all-too-prevalent chronic medical condition.<br /><br />Steven Y. Park, MD<br />http://www.doctorstevenpark.comdoctorstevenparkhttps://www.blogger.com/profile/06418947567549628690noreply@blogger.com