Re: UPPP-Is it so bad?
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Re: UPPP-Is it so bad?

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Posted by sleepsurgeon on March 02, 2009 at 08:07:35:

In Reply to: Re: UPPP-Is it so bad? posted by Captin Cannuck on March 02, 2009 at 06:35:21:

Dear Captain,

As I have mentioned, sleep apnea is a progressive problem. The natural history of sleep apnea is that it worsens with aging. Regardless of treatment, whether it is CPAP, oral appliance or surgery, patients do gradually deteriorate. The rate of worsening is quite variable between individuals. Therefore, it is not just the UPPP result doesn’t last forever. For example, I have seen many, many patients that were improved on CPAP for a year or two, but symptoms worsened and despite adjusting the pressure, their “improved state” is never recaptured. It is the same for oral appliance as well. Overwhelming majority of patients on CPAP or oral appliance are “improved” rather than “cured”, just like surgery. The degree of improvement also varies greatly. Obviously, one of the important factors I have not mentioned is that although UPPP achieves improvement, it doesn't mean that the improvement is sufficient in all patients, clearly. It is the same for patients on CPAP and oral appliance. That is why many CPAP patients are also using Provigil to help manage their symptoms. In my opinion, the key is to offer all the available options, i.e. CPAP, oral appliance and surgery. My responsibility to my patients is to try to help them manage their health problem. I try to provide accurate information pertaining to all treatment options rather than offer a single treatment. That is the problem that I have with some sleep physicians, ENTs and oral surgeons. Depending on their specialty, they only offer ONE option. It is routine for me to offer a combination treatment, such as surgery along with oral appliance, or CPAP with limited surgery. Dr. Elshaug is correct in that UPPP only helps for a short amount of time in some patients. Again, I would point out that it is a patient selection problem in the papers that he has evaluated. Those papers looked at all comers and UPPP/nasal surgery was the only surgical approach. Clearly, some of the patients should go straight to MMA as I do not believe in the phased surgical protocol for most patients. I know I perform more MMAs for sleep apnea than anyone, but should MMA be offered to all patient right from the start? That is another topic I will tackle in the near future.

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