Snoring And Apnoea Blog

Surgery For Sleep Apnoea Ineffective

Posted on Wed, Apr 06, 2011

According to an article published in the British Medical Journal, surgery on the upper airway had “…very little impact on symptoms…” of sleep disordered breathing. 

The article was based on a study by Dr Adam Elshaug at Adelaide University, who also found that even subjective improvements (i.e., perceived quality of life) rarely lasted more than one or two years.

More worryingly, 62% of the reviewed patients suffered persistent adverse effects, including difficulty swallowing, voice changes, smell and taste disturbances, and dry throat.

This is only partly surprising.  The Sleep Therapy Clinics do not provide any type of surgical treatment for sleep disordered breathing conditions -- but if surgical intervention is necessary, we refer the patients to one of the excellent ENT surgeons we’re proud to work with and these specialists routinely produce excellent results.

So, we believe that surgery DOES have a place.  (For instance, when the adenoids, tonsils or tongue are enlarged, leading to a crowded upper airway.  Or when the patient has chronic nasal congestion as a result of tissue growth or malformation of the nose or septum.  And certainly in children, where enlarged tonsils and adenoids frequently cause obstructions or constriction of the upper airway.)  We will continue to refer these types of patients to professionals who can alleviate their sleep disordered breathing condition by clearing their airway.

But note that we do this AFTER the patient has been assessed for treatment via constant positive airway pressure (CPAP) or oral  appliance therapy (OAT).   Referral for surgery occurs only when alternative treatments cannot work, in line with the guidelines laid down by the Academy of Sleep Medicine — the international authority on ‘best practice’ for the treatment of sleep disordered breathing.

So why has the research found such a bad result in its review of surgical interventions?  We believe it is almost certainly because surgery is too often promoted as ‘first line’ treatment (in contradiction of the ASM’s guidelines) instead of as a last resort. 

Indeed, we have frequently treated patients who have already undergone surgery, without success.  They invariably ask “Why wasn’t I told about CPAP / OAT at the time?”

Good question.

Tags: surgery for apnoea, surgery for apnea

Surgery for Sleep Apnoea

Posted on Sun, Mar 20, 2011

News from London reports on work done by researchers at the University of Adelaide have suggested that surgery for obstructive sleep apnoea has no clear benefit and therefore should not be offered as a first treatment.

Guidelines suggest continuous positive airway pressure (CPAP) with weight and alcohol management, as the first line treatment. However, upper airway surgery is becoming increasingly popular, reports the British Medical Journal.

The study, conducted by Dr Adam Elshaug and colleagues, analysed existing evidence for upper airway surgery and found that the results of surgery were inconsistent.

Researchers re-examined seven randomised trials and found that the surgery had a general lack of impact on symptoms and, even where improvements in quality of life have been shown immediately after surgery, these were rarely sustained beyond 12-24 months.

In another review of 48 studies, it was found that up to 62 percent of patients who had surgery reported persistent adverse effects, such as dry throat, difficulty in swallowing, voice changes, and disturbances of smell and taste. Up to 22 percent regretted having surgery.

Dr Elshaug and colleagues said that weight loss and other lifestyle modification is suggested as an adjunctive treatment to CPAP, but can be difficult to achieve.

But, given the lack of clear benefit from surgery and the potential for harm indicated by currently available evidence, guidelines suggest oral appliance therapy or CPAP should be used as treatment for obstructive sleep apnoea generally.

Researchers have also said that surgery for obstructive sleep apnoea should be done within controlled clinical trials. Patients should be informed about the trial, as well as of the inconsistent results of surgery, the associated pain, the potential side effects, and the potential for relapse.

The study is published in BMJ. (ANI)

Tags: surgery for apnoea, apnea surgery, apnoea surgery, surgery for apnea

Patient Dissatisfaction With Surgical Treatments For Apnoea

Posted on Fri, Oct 08, 2010

According to a study published recently in the Journal of Laryngology & Otology, a massive 61% of patients stated they would not choose to undergo uvulopalatopharyngoplasty (UPPP) again.   This is despite the fact that UPPP is one of the most commonly used surgical procedures for the treatment of obstructive sleep apnoea / apnea.

UPPP is a common but painful surgical treatment for apnoea / apneaThe study found that the long term success of the UPPP operation is only 45%, with the majority of patients suffering extended periods of severe post-operative pain.

Noted consequences of UPPP surgery include voice change and a tendency to regurgitate food through the nostrils.

You can read the abstract at:

As always, surgical intervention should be considered a last resort - in line with current medical protocols.  UPPP is recognised as one of the most painful forms of surgery, with a long (approx 6 week) recovery period.  Given the low and non-permanent success of this form of treatment, why choose this option when painless and highly effective alternatives exist?

That said, we have nothing against surgical intervention as treatment for snoring and apnoea / apnea when it is truly necessary.  We regularly refer patients to Ear, Nose & Throat surgeons to remove or reduce excess or floppy tissue -- but only after we've explored all other options.

Tags: surgery for apnoea, UPPP, surgery for apnea