I am 43-years-old, active, not over-weight. But I have perform heroic snoring at night, which swells my uvula and then further promotes the snoring and then apnea. I have been seen three times by the Otolaryng... doctor and the sleep apnea doctor and have tried a CPAP machine for some time now... (6 months) very ineffectively. I pull the mask off of my face nightly. My blood pressure continues to slowly rise from lack of sleep and my ability to concentrate declines... I have been scheduled for UP3 surgery three times and cancelled all three because of the drastic nature of it. I am a swimmer (coach and participant). I like to sing. And I do announcing on the side. Is UP3 effective for most of the persons who undergo treatment. I have heard that you can loose your sense of smell and taste amoung a myriad of other horror stories. Please educate me.
Reply: ------------------------------
The initial treatment of choice for obstructive sleep apnea in the majority of cases is with CPAP (continuous positive airway pressure) which is delivered via a mask that fits over ones nose. Compliance with this type of treatment can be difficult due to a variety of reasons including discomfort, ill-fitting masks, aerophagia (swallowing of excess air), claustrophobia, etc. Patient compliance and comfort can be greatly improved by closely working with the technician who services the CPAP machine - better fitting masks, humidification, the use of BiPAP in cases where high pressure requirements are present, proper pressure titration, etc. In some cases, even highly expert technical assistance fails to overcome the intolerance to CPAP and if the sleep apnea is moderate or severe, sleep apnea surgery will most likely be recommended. The gold standard for any type of treatment for sleep apnea is a tracheotomy which involves the creation of a small opening in the windpipe through the skin below the voice box thereby bypassing the collapsible portion of the breathing passage. This is the most effective sleep apnea treatment - surgical or non-surgical - but may not be desirable for a variety of reasons. The most commonly recommended surgery is known as uvulopalatopharyngoplasty (UPPP) which involves a plastic surgical operation on the palate whereby the uvula is removed and the tonsillar pillars approximated to widen the dimension of the nasopharyngeal airway. In some cases, this surgery is combined with nasal surgery to improve the nasal airway. UPPP surgery alone is only successful in 40 -70% of patients (success is defined as lowering of the sleep apnea index by 50% or more). These rates may be higher when surgical correction of nasal airway obstruction is combined with UPPP. The potential risks of UPPP include bleeding, velopharyngeal insufficiency (difficulty closing the back of the throat during swallowing thereby allowing liquid to reflux upwards into the nasal passage), amongst others. Serious complications such as the 2 mentioned are however uncommon to rare when surgery is properly performed. Long term or permanent taste disturbances following UPPP would be rare but temporary taste disturbance can occur due to pressure exerted on the tongue base during surgery. Smell disturbance would not be considered a potential risk of UPPP surgery.
There are a wide variety of other surgical and non-surgical therapies that are currently under investigation.
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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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