Palate Implants Improve Sleep Apnea

[Guest guest]

Palate Implants Improve Sleep Apnea

http://www.4woman.org/news/english/535001.htm

MONDAY, Sept. 18 (HealthDay News) -- A minimally invasive surgical

technique that involves the insertion of small polyester rods into

the soft palate may be an effective, long-term treatment for mild-to-

moderate obstructive sleep apnea.

Dr. Regina P. of the Hinsdale Medical Center in Hinsdale,

Ill., and colleagues tested the Pillar procedure in 22 middle-aged

patients, including 16 men and six women, with mild-to-moderate sleep

apnea. Although some of the patients had previously tried a treatment

called continuous positive airway pressure (CPAP), none had undergone

any earlier surgery for their sleep apnea.

After 90 days, 17 of the subjects showed significant improvements in

their snoring intensity, daytime sleepiness and apnea hypopnea index,

a measure of breathing interruptions that occur during sleep. Most

significantly, these results were sustained after 15 months,

indicating that the improvements could be permanent, according to

.

Overall, the patients' apnea hypopnea index decreased from a mean of

19.5 to 13 events per hour after 90 days, and to 12.8 events per hour

after 15 months.

was expected to present the study at the 110th annual meeting

of the American Academy of Otolaryngology-Head and Neck Surgery

Foundation, being held Sept. 17-20 in Toronto, Canada.

" This is an important study, " said Dr. Friedman, chairman of

head and neck surgery at Rush-Presbyterian-St. Luke's Medical Center

in Chicago. " Sleep apnea is a huge problem affecting at least 12

million Americans. If you count very mild forms of sleep apnea, the

number goes up to 50 million. "

In sleep apnea, breathing stops or gets very shallow during sleep.

Each pause in breathing typically lasts 10 to 20 seconds or more.

These pauses can occur 20 to 30 times or more an hour. The most

common type of sleep apnea is obstructive sleep apnea, according to

the U.S. National Institutes of Health.

Even mild forms of sleep apnea can increase a person's risk of

cardiovascular disease by five times, Friedman said. The condition is

also associated with an increased risk of high blood pressure, weight

gain, memory problems, depression and impotence.

Until the Pillar procedure was introduced about six years ago,

patients with sleep apnea only had two treatment options: CPAP, a

machine that keeps the airways open during sleep; and invasive

surgery to remove excess tissue in the mouth and throat.

Although both treatments are effective, they have drawbacks, Friedman

said. Because many patients are unwilling or unable to use a CPAP

machine, compliance is only about 40 percent. And the results of

invasive surgery tend to diminish after a year as tissues loosen and

symptoms return, he said.

During the in-office Pillar procedure, patients receive a local

anesthetic before several polyester rods are inserted into their soft

palate. Pain is usually minimal and can be managed with over-the-

counter medications.

Most patients can resume full activity the same day and return to

their usual diets after a day or two. They usually can't even feel

the implants after a week or two. Rarely, implants work their way to

the surface and must be re-implanted, Friedman said.

It's not the rods themselves that tighten loose tissue and reduce

symptoms of sleep apnea, but the scar tissue that forms around

them. " Scar tissue tends to become more effective over time, "

Friedman said. " That's why this study is important, because it shows

that the results are stable or even better after 15 months, whereas

the results of invasive surgery drop off after a year. "

Although most of the patients in 's study were overweight or

mildly obese, the Pillar procedure isn't recommended for patients who

are morbidly obese. Friedman estimated that up to 50 percent of sleep-

apnea patients are candidates for the procedure, but said it probably

would be a stand-alone treatment for only about half of them.

" The nice thing about this procedure is it doesn't eliminate the

possibility of other procedures, " said. " Quite often, we can

combine many treatments. Studies are now being done on implant

patients who use CPAP machines to see if it's possible to reduce CPAP

pressure. "

The Pillar procedure costs about $1,500, which insurance may cover in

patients with diagnosed sleep apnea but not in patients who simply

have snoring problems. " It's still a fairly new procedure that

doesn't have a specific CPT code, " said. " I would say that

about 25 to 30 percent of procedures in sleep-apnea patients are

being paid for, although the number appears to be increasing. "

Some doctors are using the Pillar procedure to treat severe sleep

apnea. " But this hasn't been well-studied, " said. " So, it's

too early to say if the implants will be of benefit to such patients. "