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Surgery, Oral Devices Associated With Improvement in Obstructive Sleep Apnoea CHICAGO -- May 18, 2009 -- Treatment with surgery or an oral appliance that adjusts the jaw is associated with improvements in obstructive sleep apnoea, according to 2 studies published in the May issue of Archives of Otolaryngology-Head & Neck Surgery. This may be a viable option for patients who cannot tolerate continuous positive airway pressure (CPAP). "Patients with obstructive sleep apnoea who cannot tolerate or refuse CPAP therapy may be considered for surgical treatment," wrote Neville Patrick Shine, St. Johns Hospital, Edinburgh, Scotland, and Richard Hamilton Lewis, Royal Perth Hospital, Perth, Australia. Drs. Shine and Lewis reviewed the medical records of 60 patients (55 men, 5 women; mean age 47.5 years) undergoing surgery to treat obstructive sleep apnoea between 2002 and 2006. All participants underwent sleep testing before and after surgery. As measured by the number of sleep disturbances and arterial oxygen saturation, surgery was considered successful in 38 of the 60 patients (63%). Sleep apnoea was completely cured in 21 patients (35%). No associations were found between preoperative characteristics, including demographic, historical, and clinical variables such as disease severity or obesity, and surgical outcome, suggesting that it may be difficult to predict which patients will respond well to the procedure. "To our knowledge, this is the largest series reported to date regarding the transpalatal advancement pharyngoplasty procedure," the authors concluded. "It should be considered in patients in whom conservative management has failed and who are willing to undergo surgery to improve the retropalatal airway." In the second study, Chul Hee Lee, MD, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, and colleagues evaluated 50 Korean patients (46 men, 4 women; mean age 50.2 years) who received an oral device to treat obstructive sleep apnoea between 2005 and 2007. The mandibular advancement device prevents airway obstruction by moving the lower jaw forward. Patients underwent sleep testing by polysomnography before and at least 3 months after receiving the device, completed questionnaires about sleep quality, and sleepiness and had several measurements of their tongue and throat areas taken and analysed. As defined by the number of episodes of shallow or stopped breathing per night, the device was considered successful in 37 of 50 patients (74%). This included 3 of 7 patients with mild cases of obstructive sleep apnoea (43%), 22 of 27 with moderate cases (82%) and 12 of 16 with severe cases (75%). No differences were seen between patients who did and did not respond successfully to treatment with regards to demographic data or data gathered during sleep testing. "In conclusion, the mandibular advancement device is a simple, non-invasive, easy-to-manufacture and easy-to-use device and showed good treatment outcome in nocturnal respiratory function and sleep quality in Korean patients with obstructive sleep apnoea," the authors wrote. "Even in patients with severe obstructive sleep apnoea, mandibular advancement device application showed a good success rate. Hence, mandibular advancement device application can be used as a good alternative option in patients with obstructive sleep apnoea, without patient selection, and could be used in patients with severe obstructive sleep apnoea." SOURCE: Archives of Otolaryngology-Head & Neck Surgery E-mail this page to a friend or colleague! To print, use this version