Obstructive Sleep Apnea Surgery: Tracheotomy

Allen Blaivas, M.D. Health Pro
  • We spoke extensively about the surgical treatment options for OSA in our last blog. I wanted to hit upon one last type of surgery and complete a discussion of other treatment options.

     

    The most successful surgery for OSA is called a tracheotomy. It entails making a small whole in the trachea (wind pipe), which effectively bypasses the entire upper airway, and is able to cure sleep apnea. Despite its great success at treating sleep apnea, it is not commonly used because of the poor acceptance in society of this disfiguring treatment. Tracheotomy also can cause problems with infections, another reason for its relatively rare use.

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    As we pointed out previously (see last blog), surgery is not for everyone, and is usually reserved for cases of moderate-severe OSA associated with severe daytime sleepiness or other serious medical problems, in patients who are unable to use PAP. In general, phase 1 surgeries are able to decrease the number of OSA events by 50% or more, about 50-60% of the time. Phase 2 surgeries have an 85-90% success rate, but they are much more intensive.

    There is one other treatment for OSA that needs to be discussed- oral appliances. These are devices which are usually custom made by a dentist who specializes in treating sleep apnea. These typically also come in two types: those that pull the tongue forward and others that advance the lower jawbone. These devices only need to be worn during sleep. They are less cumbersome than PAP, but similar to most the surgical techniques, suffer from limited effectiveness. As with surgery, these devices vary in efficacy, ranging from a 45-65% improvement, depending on how severe the OSA is.

     

    These three types of treatments, positive airway pressure, oral appliances, and surgery are considered the only three types of therapy the have been medically proven. There have been a number of prescription and non-prescription medications that have been studied that have not been shown to work. The use of complementary medicine in America has increased over the years for many medical problems, sleep disorders included. Despite the manufacturer's claims to the contrary these therapies including herbal therapies, nasal dilators (like Breathe Right strips), nasal lubricants, and magnets may be helpful for snoring, but can not be considered adequate treatment for OSA.

     

    Some other things that can help improve sleep apnea are weight loss and positional therapy. Weight gain and obesity are both considered risk factors for developing OSA and therefore it stands to reason that weight loss may help. It surprisingly won't eliminate OSA, but usually can improve the severity.

     

    Positional therapy can work well for someone who mostly has OSA when he is lying on his back. This is the most common position to have the obstructive events, so staying off the back may help. A simple way to do this is to sew a golf or tennis ball into the back of a pajama shirt. When the OSA sufferer tries to lie on his back it is uncomfortable and he is forced to sleep on his side or stomach, which makes him less prone to have apneas.

  • There are other innovative procedures being explored for the treatment of OSA that have shown good early results, but are still considered experimental. Even with all these treatment options, PAP is still considered the primary treatment. But, with the long-term compliance rates for PAP around 50-60%, there is every reason to believe that both surgical and nonsurgical alternative will be aggressively explored to replace PAP.

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    I expect that in 15-20 years few people will still require PAP machines to treat their sleep apnea, I just wish I could tell you which company's stock to buy now!

     

     

     

     

     

Published On: March 17, 2008