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Sleep Surgeon Question 21

Question 21 - Need help deciding if surgery is right for me.

From: K. B.

I am a 20 year old female with a history of sleep apnea. I am 5'10 and 145lbs. I am not overweight. My RDI and AHI is 22 and my O2 drops to 87%. The best treatment that helped me was cpap at 17 cm of h2o. That lasted for only a month because the high pressures severely hurt and dried out my sinus's.

So therefore, after a year of trying and playing with different cpap masks, humidifier, the cpap is a huge miss, which is why ive moved on to getting surgery. I have already had my deviated septum fixed and my tonsils/adnoids removed. This did not improve my OSA..

The first surgeon I went to gave me the orthogantic work up and said that i was a canadate for MMA and GA. The second one I went to said that i was definetly not a candidate for that, and that the UPPP along with the hyoid suspension and genioglossal advancement would cure me.

Let me just say that I have had to stop going to college and even give up my scholarship because this disorder is ruining my life due to intense daytime sleepiness. My quality of life is truly diminished. I want this disorder cured...all i know is that I DO NOT snore and I am not overweight. When i sleep, my mouth drops open and the tip of my tongue hits the roof of my mouth (due to it collapsing).

Please, i need advice. I need to get my life on track, and i just want to make sure i make the right decision. -

thank you

Answer Provided by Dr. Kasey Li
August 29, 2007

In general, young women with moderate to severe OSA either are quite overweight (the main cause of OSA is due to the weight issue) have or significant upper airway narrowing (the main cause of OSA is due to the small upper airway).

Additionally, women usually do not have much excess soft tissue, thus young, non-obese women with significant OSA usually have small jaws. Obviously, this is an assumption since I have not examined you.

Since the natural history of OSA is that it progresses with age, therefore, I usually recommend that young patients such as your self try to maximize the improvement with surgery.

There is no question that MMA achieves the best improvement and that is what I would probably recommend. However, you can certainly consider hyoid advancement with genioglossus advancement and palatopharyngoplaty. It can be a viable option if you have tonsils, which improves your chances.

I don’t know how experience your surgeon is, but women’s hyoid bone is much smaller and softer and there is a greater chance of fracture during the operation as compared to men.

My best advice would be for you to evaluate the odds of success and your comfort level in going through these operations.

Good luck.