I am a hypotensive 67-year-old male who two years ago had quadruple
bypass surgery, and who has now been diagnosed as having sleep apnea,
also a defected septum and enlaged turbinates. A CPAP was prescribed,
with Claritin and Fluonase to clear my nasal passages. That worked
briefly, but the medications are no longer effective, so that when I can
use the CPAP sleep is disturbed and I wake with 165/90 BP. I have tried
using a full-face CPAP mask, but the medium size is to small and the
large size too big. I presume that my only choice left is the nose
surgery you explained so well in answer to others.
If so, I would like another surgery to try to eliminate the need for a
CPAP. I would like to avoid a Uvulopalatopharyngoplasty, because I am
highly sensitive to pain, and anyhow, I believe, it is often
unsuccessful. Would the Laser Assisted Uvulopalatoplasty described by
Dickson and Mintz in The Journal of Otolaryngology. Volume 25, Number 3,
June 1996, be a good alternative in my case?
Reply: ----------------------------
Laser assisted uvulopalatoplasty (LAUP) is a relatively new surgical procedure that is used to treat loud heroic snoring. It is not designed to treat obstructive sleep apnea. It is primarily intended to treat bothersome snoring that is a significant social or marital problem. Patients who are considered possible candidates for a LAUP must be screened for obstructive sleep apnea and if it is present alternative therapies such as CPAP or other surgical procedures are advised.
Most patients with obstructive sleep apnea are initially advised to undergo a trial of nasal CPAP which is generally highly effective, but not always well tolerated due to the necessity of wearing a mask delivering oxygen under pressure through the nasal passages. Certain patients who do not tolerate CPAP because of nasal airway obstruction are considered candidates for nasal surgery including septoplasty and/or turbinate surgery to improve nasal airflow and ultimately to improve tolerance and effectiveness of CPAP.
If CPAP is not tolerated at all, surgical intervention is usually advised particularly if the obstructive sleep apnea is of moderate or severe degree. Surgical procedures used to treat obstructive sleep apnea include nasal surgery (such as septoplasty or turbinate surgery), adenotonsillectomy, uvulopalatopharyngoplasty (UPPP), or for the most severe cases, tracheotomy. Other surgical procedures designed to augment the airway of the lower throat are also being investigated. In many cases combinations of the above are recommended depending on a pre-operative evaluation which identifies the area in the breathing passages where obstruction appears to be the greatest. Unfortunately, surgical procedures involving the palate or the palate and nasal airway, are not as highly effective as we would hope they would be, and this is felt to be due to obstructive problems in the lower part of the throat known as the base of the tongue. Tracheotomy on the other hand is the gold standard by which all treatments (surgical or non-surgical) are measured in terms of effectiveness. This is because a tracheotomy involves placement of a small opening in the windpipe (a relatively rigid tube) that is well below the collapsible portion of the upper airway. Our ability to improve the effectiveness of surgical treatments for obstructive sleep apnea largely depends on improving the ability to accurately locate the areas of major obstruction in an individualized manner, which is the subject of considerable research presently.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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