Surgery Proves Effective for Sleep Apnea

Study Suggests Slight Survival Advantage for Surgery

From the WebMD Archives

Sept. 19, 2003 -- New research suggests that surgery is an effective, and too often overlooked, treatment for many people with sleep apnea.

Sleep apnea occurs when the airway repeatedly becomes blocked during sleep, causing breathing to stop for 10 seconds or longer, sometimes hundreds of times a night. Treatment is key because people with sleep apnea who remain untreated have an increased risk of dying from heart disease (resulting from a rise in blood pressure when oxygen levels drop).

The most widely used treatment for sleep apnea is CPAP -- continuous positive airway pressure. The treatment involves wearing a mask while sleeping at night -- something that many people cannot or will not do. Millions have sleep apnea and don't know it, and many others have been prescribed CPAP, but don't use it.

Researchers for the study followed a group of veterans for one to five years. Each was treated with either surgery or CPAP for obstructive sleep apnea -- named so because it's usually due to a blockage from enlarged tissues in the nose, mouth, or throat.

They found that the group treated with surgery had a slight (22-day) survival advantage over those prescribed CPAP. The findings are to be presented at the annual meeting of the American Academy of Otolaryngology Head and Neck Surgery this month.

It was not clear if the CPAP patients actually used the pressure masks, however. Even though the treatment has been proven highly effective, many patients don't like to wear the devices and compliance is a major problem. Studies indicate that most patients who use CPAP during sleep do so only about half the time.

"We can't say from these data that surgical therapy is superior to CPAP," researcher Edward M. Weaver, MD, of the University of Washington tells WebMD. "But we can definitely say that if a patient isn't using CPAP or is only using it occasionally, they should be considered for surgical therapy."

5 Times the Risk for Heart Disease

It is estimated that as many as 18 million Americans have sleep apnea. The condition is linked to an increased risk of heart attack and stroke. One study found that men with the disorder were five times more likely to develop heart disease.

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The more than 32,000 middle-aged veterans included in the study were either prescribed CPAP or the most widely used surgery for sleep apnea, in which the back of the soft palate is trimmed or shortened to allow air through more easily.

The surgical procedure is not considered as effective as CPAP, but Weaver says this may be a misconception.

"A significant percentage of patients -- roughly 80% -- show some improvement with surgery," he says. "When you consider this and the fact that so many patients on CPAP are non-compliant, surgery makes sense for a lot more people. The message is that surgery is an effective option for many patients who aren't doing well with CPAP."

Monitoring Is Key to Success

The veterans included in the study will continue to be followed, and Weaver says he expects the survival advantage for the surgery group to grow over time.

But sleep disorders researcher Carl E. Hunt, MD, says surgery is not an appropriate option for all sleep apnea patients who don't comply with CPAP treatment. He adds that many patients who think they can't get used to the devices can be trained to do so with the help of a sleep specialist.

Hunt is director of the National Center on Sleep Disorders Research, a division of the National Institute's of Health's National Heart, Lung, and Blood Institute.

"Many people with sleep apnea are not treated by specialists, but by their primary care physicians," he tells WebMD. "They are often prescribed CPAP and then sent home with little or no monitoring, and they don't have access to the troubleshooting they need to make the treatment work. Careful monitoring is critical, but too often overlooked. CPAP works, but only if a patient uses it."

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Sources

SOURCES: American Academy of Otolaryngology Head and Neck Surgery annual meeting, Sept. 21-24, Orlando, Fla. Edward M. Weaver, MD, MPH, chairman, AAOHNS sleep disorders committee; assistant professor of otolaryngology, surgical program; director, sleep disorders center, University of Washington, Seattle, Wash. Carl E. Hunt, MD, director, National Center on Sleep Disorders Research, Bethesda, Md.
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