How effective CPAP in OSA and Snoring

Not very effective, I would say. Let me explain.

Obstructive sleep apnea is caused by mechanical obstruction in the upper air passage and how can the CPAP work effectively unless one remove the obstruction. Answer is simple.

I agree CPAP therapy is very useful for patients having Central sleep apnea and but not for all cases of obstructive sleep apnea. Those who are unfit for OSA surgery may be helped to some extent. Old age is not a contra indication for surgery (I have done several cases of laser surgery under local in patients who are older than 80)

Introduction

One-third of a lifetime is meant for sleep. That is more than enough reason to pay attention to it, especially when help is so at hand. Snoring isn\’t a sign of sound sleep. On the contrary, it is the sign of a serious sleep disorder called obstructive sleep apnea (OSA).

There are three types of sleep apnea:

and Central sleep apnea (CSA) occurs when the brain does not send the signal to the muscles to take a breath, and there is no muscular effort to take a breath.

and Obstructive sleep apnea (OSA) occurs when the brain sends the signal to the muscles and the muscles make an effort to take a breath, but they are unsuccessful because the airway becomes obstructed and prevents an adequate flow of air.

and Mixed sleep apnea, occurs when there is both central sleep apnea and obstructive sleep apnea.

OSA in children

OSA is very common in kids due to enlarged tonsil and adenoid, we remove them and they are cured one hundred percent. I haven\’t heard any pediatric CPAP being available for OSA in children. Same principle applies for adults.

Remove the obstruction- That is the answer

The causes of OSA in adults are due to

and Nasal obstruction-Deviated nasal septum, enlarged turbinates, polyps and sinus infection, allergic and vasomotor rhinitis,

and Obstruction in the Nasopharynx-residual adenoid, cysts and other lesion,

and Oropharyngeal level-Enlarged Tonsils, elongated and thickened soft palate and uvula, prominent lateral pharyngeal bands,

and Tongue factor – prominent tongue base,

and Mandible-Retrognathia,

and Laryngeal level-Cysts and tumors.

Unless one removes the obstruction, I don\’t understand, how on earth, pumping air in pressure gives relief to those suffering from OSA? It has no logic.

My experience over 25 years

I started doing the conventional UPPP in 80s and then came the Laser surgery in mid 90s and recently came Coblator and Harmonic Scalpel. Lot of advances in surgical techniques and technology is available these days.

In my 25 years experience of doing corrective surgery for snoring and OSA, I might have done more than 2000 cases, many of them, mostly young and middle age group. Majority of them were frustrated and disappointed after using the CPAP being recommended after sleep studies. They just could not tolerate it. Some got really fed up, frustrated and even become like mad.

In early 80s the UPPP was done but in small numbers, due to the pain factor. But since Laser (I use Co2 Laser), the surgeries were done more frequently; many were done in the Office or minor OT under local anesthetic.

More complex cases I perform the surgery under GA, especially multiple procedures had to be performed in one sitting.

The patients who bought CPAP, had no idea of the alternatives, they were discouraged rather unfairly by the sleep labs telling that the operation is very painful and dangerous. Once the Coblator surgery started, they could not blame on the pain factor, instead they said, the recurrence rate after surgery is very high.

The surgeons doing OSA surgery world wide like me knows well what they can do, they don\’t give unrealistic expectation .In my experience 70-80% cure rate is achieved in OSA and 80-90% cure rate in Snoring.

What all surgeries done

There is not a tailor made operation to cure OSA for all patients. The cause of obstruction has to be identified first and dealt with; it can be at different areas, so a number of procedures may be needed to get good result. Septal correction, Turbinate reduction, Nasal polyp removal, Adenoidectomy, Tonsillectomy, Removal of redundant soft palate and uvula, reduction of tongue base, removal of lateral pharyngeal bands etc are the commonly done procedures. Rarely major procedure like Mandible advancement, hyoid suspension and even tracheotomy is being performed.

Conclusion

CPAP is a very useful machine in treating patients with central and mixed apnea, but those having obstructive factors causing apnea-OSA; the obstruction has to be removed surgically, rather than pumping air under pressure into their air and food passages.

*This article may sound controversial. It is only my opinion after doing surgery to cure Snoring and OSA for the last 25 years.