FEATURE
A WAKEUP CALL FOR SLEEP APNEA AUTHOR Andrew Gould , MD , FAAOA
Twenty years ago , I began private practice in ENT here in Louisville . During training , obstructive sleep apnea was not a particular area of focus . In practice , however , it quicky became obvious that this was going to be a very common patient complaint . Positive airway pressure ( PAP ) intolerance , a chief component of sleep apnea , was , and is , a very prevalent problem .
In an effort to help these patients , I applied a basic palate shortening procedure in the form of uvulopharyngopalatoplasty ( UPPP ). My experience with this treatment was similar to many ENT surgeons ’ findings : unpredictable results , coupled with significant patient morbidity . This was not an ideal outcome for any physician , much less for a young surgeon who was developing a practice .
At about the same time , in 2000 , some papers were published that both questioned the effectiveness of UPPP , and suggested that it could make the disease worse . 1 , 2 This convinced me to take a nihilist approach that nothing worked effectively . Although I was secretly relieved to give up on sleep surgery , I also dreaded seeing positive airway pressure ( PAP ) intolerant patients come into the office that clearly needed help . I would usually suggest that they try a new mask . They would respond that they had tried 10 masks and three machines . I would respond along the lines of , “ Well you just need to try harder .” The visit would end with both of us feeling frustrated . I kept wondering how a solid , helpful resolution could be achieved .
I am in fact a huge advocate of PAP . It is safe and effective for many people . However the long-term compliance has been reported to be less than 50 %. 3-5 If there are an estimated 22 million patients with obstructive sleep apnea , this would indicate that a great number of patients are not being effectively treated . This has significant societal implications , considering the increase in health expenditures due to worsening comorbidities , loss of productivity , the potential for increased motor vehicle accidents , not to mention personal and social issues due to the lack of uninterrupted restorative sleep .
Fortunately , in the past few years there have been significant technological advancements which have allowed for major progress in the treatment of obstructive sleep apnea ( OSA ). More accurate home sleep studies ( HST ), auto-pap ( PAP ), hypoglossal nerve stimulation ( HNS ) and minimally-invasive nasal obstruction treatments
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