New Stroke Risk Factor: Sleep Apnea
Death, Stroke Risk Doubles With Obstructive Sleep Apnea
Treating Sleep Apnea continued...
Paradoxically, surgery helps only the milder forms of obstructive sleep apnea.
"If there is an abnormal structure of the upper airway, then you can make a case for surgery," Somers says. "Tracheostomy is what we do. There are other kinds of surgery where we cut through the uvula, that little structure at the back of the throat, and the upper airway. That seems to work for a short while. Unfortunately, it does not appear to be a definitive treatment -- and if you have surgery, you want it to be curative. The trouble is that in six months to a year the airway gets flabby and apnea comes back."
"It is the patients with mild-to-moderate sleep apnea who respond to surgery," Yaggi says. "Patients who are not obese tend to respond better."
Mouthpieces and Masks
Another treatment for milder forms of obstructive sleep apnea is an oral appliance. This mouthpiece-like device brings the lower jaw forward and opens space in the back of the throat during sleep.
But all of the experts who spoke with WebMD agree that the best treatment for moderate to severe sleep apnea is continuous positive airway pressure or CPAP. With NYU, Rapoport holds two patents on these devices.
"We usually describe CPAP as a small mask, adjusted to fit over the nose, and connected to a source of slight air pressure -- like what you'd feel going up in an elevator," Rapoport says. "It is not a breathing machine. It only holds open the airway and keeps it from collapsing. The biggest problem for patients is getting used to it and finding a comfortable enough mask. Now there are some 200 kinds of masks, so that is becoming less of a problem."
Patients don't always use their CPAP devices as often as they should. But those who do have a good chance of relief.
"I have one patient who has been on it 24 years," Rapoport says. "Those who benefit know they do and become good about it. We have about a 75% success rate. We are up against human nature here. People, even when they know it helps, don't always use the treatment."