Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Thursday, January 20, 2011

Does CPAP cure Sleep Apnea? Do Oral Appliances Cure Sleep Apnea? Can surgery cure sleep apnea?

CPAP and Oral Appliances are not cures for sleep apnea but rather effective treatment for sleep apnea patients. They are only effective when they are used on a regular basis , all night - every night.

CPAP compliance is an enormous problem even though CPAP treatment is extremely effective. Recent studies have shown 60% of patients abandon CPAP use. CPAP that is not used is not only not a cure but is a total treatment failure.

Oral appliances while usually extremely effective for mild to moderate sleep apnea and often effective for even sever sleep apnea are much better tolerated by patients. The majority of patients chose an oral appliance over CPAP when offered a choice. Compliance with oral appliances is very high and patients who "Hate CPAP!" often love their oral appliances.

Oral appliances are also not a cure for sleep apnea just a very effective treatment. When compliance is considered along with efficacy oral appliances are probably more effective overall than CPAP. If an oral appliance is not used it does not work. Compliance is a much smaller problem with oral appliances but they are not a panacea.

Is surgery a permanent cure to sleep apnea? Surgery for sleep apnea can be curative but most surgeries fall far short of curing sleep apnea.

Soft palate surgery has a long history. Uvulopalatopharyngealplasty or UP3 surgery is extremely painful and rarely cures sleep apnea. There is a high morbidity rate with this painful surgery and most patients still require use of either CPAP or an oral appliance. Some patients have severe scarring that can drastically worsen the condition. Variations of the UP3 procedure are LAUP or Laser Assisted Uvuloplast, Somnoplasty, pillars and snoreplasty. All of these surgeries rarely if ever cure the patient but carry the severe risk of creating a "silent apneic" where snoring is eliminate but apnea is still present. MOST PATIENTS SHOULD AVOID THESE SURGICAL PROCEDURES, IF YOU DECIDE TO PROCEED WITH THESE SURGERIES I STRONGLY SUGGEST A SECOND OPINION FROM A NON-SURGEON SLEEP SPECIALIST.

Nasal surgery, correction of deviated septums and/or turbinate reductions are also not considered cures for sleep apnea but do increase nasal breathing and are helpful . I FREQUENTLY REFER PATIENTS FOR THESE PROCEDURE THAT OFTEN OFFER EXCELLENT RESULTS, BUT RARELY CURE APNEA. They almost always result in an improvement is quality of life and rarely have any long-term morbidity.

Bimaxillary advancement, usually best done by oral surgeons or plastic surgeons are frequently an effective long-term cure of sleep apnea. Orthognathic surgery is major surgery and should be carefully considered before doing surgery. The surgery consists of cutting the upper jaw away from the skull often splitting the maxilla in half as well, The lower jaw or mandible is sectioned into three sections and frequently the hyoid bone is split into three pieces. The patient is then wired shut for six weeks. The surgery is drastic and can make significant changes in patients appearances but is also extremely effective. In many patients there can be profoundly positive cosmetic results. I STRONGLY SUGGEST THAT PATIENTS CONSIDERING THIS SURGERY FIRST USE AN ORAL APPLIANCE TO ELIMINAT THEIR SLEEP APNEA. THIS WILL SERVE AS A GUIDE FOR HOW FAR THE SURGERY NEEDS TO ADVANCE THE MANDIBLE. IT IS THE BEST WAY TO INSURE THAT REPEAT SURGERY OR INCOMPLETE CORRECTION OF APNEA DOESN'T LEAVE A PATIENT WHO STILL NEEDS CPAP OR AN ORAL APPLIANCE AFTER SURGERY.

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posted by Dr Shapira at 7:57 PM