Questions about Obstructive Sleep Apnea Syndrome (OSAS)

Obstructive Sleep Apnea Syndrome is a debilitating breathing disorder which occurs during sleep. While sleeping, the body's muscles relax; this can cause excess tissue in the upper airway (back of the mouth, nose and throat) to collapse and block breathing. When breathing is interrupted by an obstruction in the airway, the brain reacts by waking the body slightly to restore muscle tone and breathing starts again.

These events, called arousals, may occur hundreds of times each night but do not fully awaken the patient, who remains unaware of the loud snoring, choking and gasping for air that are typically associated with Obstructive Sleep Apnea Syndrome. Obstructive Sleep Apnea Syndrome sufferers seldom get "a good night's sleep" because repeated apneas and arousals deprive patients of REM and deep-stage sleep, leading to chronic daytime fatigue, sleepiness and increased risk of high blood pressure, heart attack and stroke. (Back to Top)

What are the health implications of Obstructive Sleep Apnea Syndrome?

Obstructive Sleep Apnea Syndrome has a profound impact on an individual's health. Excessive daytime sleepiness caused by disruption of normal sleep patterns leads to loss of productivity and ability to concentrate. It also leads to a significant increase in the rate of accidents, including a sevenfold increase in automobile accidents. Obstructive sleep apnea is also associated with greater risk of cardiovascular diseases such as hypertension, heart attack and stroke. The National Commission on Sleep Disorders Research estimates that 38,000 cardiovascular deaths occur each year due to sleep apnea.

Loud snoring and breathing interruptions can also affect the quality of sleep of the Obstructive Sleep Apnea Syndrome patient's bed-partner. Witnessing an apnea (apnea is defined as a cessation of breathing for 10 seconds or greater) can be a frightening experience because the Obstructive Sleep Apnea Syndrome patient appears to be suffocating. Frequently, it is a sleep-deprived bed partner who convinces the patient to seek medical help. (Back to Top)

Who suffers from Obstructive Sleep Apnea Syndrome?

Although Obstructive Sleep Apnea Syndrome is commonly associated with obesity, male gender and snoring, it affects a broad cross-section of the population including children. It is estimated that twenty-four percent of adult men and nine percent of adult women, or more than 20 million Americans, have some degree of Obstructive Sleep Apnea Syndrome. Of these, six million are estimated to have cases severe enough to warrant immediate therapeutic intervention. However, Obstructive Sleep Apnea Syndrome was not well understood or recognized by primary care physicians until recently and only a fraction of these 20 million Obstructive Sleep Apnea Syndrome patients have been diagnosed and treated. With increased awareness, a growing number of new patients are expected to be identified for treatment in the next few years. (Back to Top)

What are some of the treatments for Obstructive Sleep Apnea Syndrome?

Available treatments for Obstructive Sleep Apnea Syndrome include medical and surgical therapy. Medical therapy consists of nightly use of continuous positive airway pressure devices (CPAP). During sleep, CPAP patients wear a face mask connected to a pump that forces air into the nasal passages at pressures high enough to overcome obstructions in the airway and stimulate normal breathing. In general, CPAP should be worn for at least 6-8 hours a night and 7 nights per week to maximize its benefit. Although CPAP is effective, some patients find the mask very uncomfortable, claustrophobic or embarrassing. CPAP patients often suffer from side effects related to forced air delivery including nasal dryness, congestion, sore throat, sore eyes, headaches and abdominal bloating. A significant number of CPAP patients do not use the device nightly and may discontinue treatment on their own. Since CPAP is not a cure and must be used every night for life, non-compliant patients experience a full return of Obstructive Sleep Apnea Syndrome and related symptoms.

A Dental Oral appliance is also a form of medical therapy. The dental device causes the lower jaw to protrude forward while the patient is asleep. This treatment is supposed to enlarge the airway opening at the back of the tongue. The problem with this treatment is that it may be ineffective, and even when the patient experiences some benefit, the long-term use of such device may lead to drooling, tooth movement and jaw joint (TMJ) pain.

Surgical therapy for treating Obstructive Sleep Apnea Syndrome is based on identifying the sites of airway obstruction including the nose, soft palate and tongue. The procedures that are effective in clearing specific areas of blockage include nasal reconstruction, uvulopalatopharyngeoplasty (UPPP), mandibular osteotomy with genioglossus advancement, hyoid myotomy and suspension, and maxillomandibular advancement. Nasal reconstruction improves the opening inside the nose by straightening the nasal septum and shrinking the fleshy tissue inside the nose (turbinate), thus improving nasal airway. UPPP involves the removal of the uvula, part of the soft palate, tonsils and possibly other excess tissue in the throat. Mandibular osteotomy with genioglossus advancement as well as hyoid myotomy and suspension clear the obstruction in the back of the tongue. Maxillomandibular advancement is a very effective surgical technique to clear significant upper airway obstruction by moving the upper and lower jaws forward. (Back to Top)

How does Radiofrequency treat Obstructive Sleep Apnea Syndrome?

Radiofrequency is minimally invasive and less painful treatment of upper airway soft tissue obstructions. Radiofrquency treats sleep apnea by shrinking excess soft tissue in the upper airway including the base of tongue, soft palate and nasal tissues (turbinate) under local anesthesia. The radiofrequency system includes an automated RF generator with temperature monitoring capabilities using a disposable surgical handpiece with a needle electrode that delivers controlled thermal energy into targeted areas to reduce tissue volume and stiffen soft tissue.

The radiofrequency procedure for Obstructive Sleep Apnea Syndrome generates low heat (approximately 85 C) to create finely controlled coagulative lesions at precise locations within the upper airway. An insulating sleeve at the base of the needle electrode is intended to protect the surface of the tissue from thermal damage, thereby minimizing post-operative discomfort. The lesions created by the procedure are naturally resorbed in approximately three to eight weeks, reducing excess tissue volume and opening the airway. Typically, the procedure for Obstructive Sleep Apnea Syndrome takes 30 to 45 minutes, with only five to 10 minutes required for actual radiofrequency energy delivery. The procedure is commonly performed on an outpatient basis and patients can usually return to their normal activities the following day. Typically, more than one treatment is necessary to achieve optimal results except for nasal treatments where one treatment is standard. (Back to Top)

What does the patient experience during the radiofrequency treatment?

Radiofrequency treatment for Obstructive Sleep Apnea Syndrome is performed under local anesthesia in an outpatient setting. The protection of the delicate surface of the tissue, the controlled delivery of energy and the ability to maintain a constant, low temperature present a sharp contrast to conventional surgery. Patients undergoing traditional surgery may suffer significant pain and usually require narcotic medications for several weeks. Patients undergoing radiofrequency treatment can experience some swelling and discomfort after the procedure, and may require pain medications for two to three days. (Back to Top)

How effective is radiofrequency in the treatment of Obstructive Sleep Apnea Syndrome?

Our initial clinical results reported that radiofrequency therapy may effectively treat Obstructive Sleep Apnea Syndrome safely by shrinking a portion of the base of tongue, in moderately and severely affected patients with OSAS. These results demonstrated that patients experienced, in this pilot study, an average of 17 percent and as much as a 35 percent reduction in tongue tissue volume, a range comparable to conventional surgical techniques. We also found there were no post treatment problems with speech or swallowing after completion of treatment. (Back to Top)

Who is a candidate for the radiofrequency procedure for Obstructive Sleep Apnea Syndrome?

All potential candidates should be carefully evaluated by a physician to confirm the presence of Obstructive Sleep Apnea Syndrome (through an overnight sleep study) and identify the possible sites of airway obstruction that would benefit from selected treatments using radiofrequency technology. (Back to Top)

What postoperative follow-up do you need after any form of surgical, laser or radiofrequency treatment?

1. Frequent office follow-ups to be sure that diet, wound and oral hygiene as well as sufficient pain control is established.
2. The wounds need to be inspected until complete healing has occurred. Fiber-optic visualization of your airway and X-rays aid in evaluating the caliber of your airway postoperatively.
3. Fiber-optic visualization of your airway and X-rays aid in evaluating the healing process and the overall outcomes of the surgery postoperatively.
4. If you have moderate or severe sleep apnea you need to use nasal CPAP, nasal BiPAP or a tracheotomy until a repeat sleep study reveals your disease is cured.
5. Approximately four to six months postoperatively, a repeat sleep study is performed to evaluate the result. These studies will then be reviewed with the individual patient and recommendations made as to follow up or a next step. (Back to Top)