Base Of Tongue Surgery Not Recommended For Moderate Or Severe Sleep Apnea

PRLog (Press Release) - Aug 24, 2009 -
Sleep apnea is a serious condition that has dire medical consequences.  CPAP is called the Gold Standard for sleep apnea treatment unfortunately the majority of patients reject or fail CPAP.  Studies have shown that only 23-45% of patients utilize CPAP on a regular basis.  The American Academy of Sleep Medicine has accepted treatment of mild to moderate sleep apnea with oral appliances as a first line approach along with CPAP.  Oral Appliances are considered an alternative treatment for severe sleep apnea when patients do not tolerate CPAP.  Information about oral appliance therapy and Dental Sleep Medicine is available @ http://www.ihatecpap.com/oral_appliance.html

Surgical treatment for sleep apnea is usually not considered a first line approach but may be considered for patients who do not tolerate CPAP and/or oral appliances.  This study showed a higher morbidity with a base of tongue surgery relative to radiofrequency surgery when combined uvulopalatopharyngealplasty (UP3).  The success rate was over 50% however success was defined as a 50% reduction in apnea.  Even the successful cases may still require CPAP or Oral Appliance therapy because the definition for success was set very low.  In obese patients the success rate was significantly lower, only 10-12 1/2 % .

Based on these findings one must question the use of UP3 surgery combined with ase of tongue surgery.  This author would recommend patients be educated to the high success rates of Dental Sleep Medicine if they do not tolerate CPAP.

Dr Shapira is a Diplomate of The American Board of Dental Sleep Medicine.

The Pub Med abstract is listed below for your convenience.

1: Otolaryngol Head Neck Surg. 2009 Jun;140(6):917-23. Epub 2009 Apr 15.Links
Randomized study comparing two tongue base surgeries for moderate to severe obstructive sleep apnea syndrome.

Fernández-Julián E, Muñoz N, Achiques MT, García-Pérez MA, Orts M, Marco J.
Otorhinolaryngology Department, Hospital Clínico Universitario, University of Valencia, Valencia, Spain. fernandez_enr@gva.es
OBJECTIVE: To compare the effectiveness and morbidity of the tongue base radiofrequency and tongue base suspension techniques combined with uvulopalatopharyngoplasty for moderate to severe obstructive sleep apnea. STUDY DESIGN AND SETTING: Prospective and randomized surgical trial at a university hospital. METHODS: In total, 57 patients received either tongue base radiofrequency reduction (n = 29) or tongue base suspension (n = 28). Apnea-hypopnea index, lowest oxygen saturation (polysomnography), Epworth score, and side effects were assessed. Success was defined as a > or =50 percent reduction and final apneahypopnea index < 15/h, and an Epworth score < 11. RESULTS: The success rates of the two procedures were 57.1 percent and 51.7 percent, respectively (P = 0.79), but only 12.5 percent and 10 percent, respectively (P = 0.87), in obese patients. Body mass index (P = 0.0002) was the main predictor of success in a logistic regression analysis. Tongue base suspension demonstrated higher morbidity (P < 0.05). CONCLUSIONS: The effectiveness of tongue base suspension was similar to that of tongue base radiofrequency reduction, although with significantly higher morbidity, for moderate to severe obstructive sleep apnea. The effectiveness of both techniques was lower in obese patients. SIGNIFICANCE: Neither technique should be used in obese patients who have moderate to severe obstructive sleep apnea.
PMID: 19467415 [PubMed - indexed for MEDLINE]