December 6, 2010
Sleep Apnea & Treatment Advances
William Gross, MD: otolaryngologist
MIDDLE TENNESSEE MEDICAL CENTER
NEW TransOral Robotic Surgery (TORS) for Sleep Apnea at MTMC
Obstructive sleep apnea ("sleep apnea") is a disorder where the soft tissues of the throat collapse on inhalation during sleep, causing disruption in the normal breathing process. Sleep apnea can be very problematic as the disruption in a patient's breathing results in decreased oxygen delivery to the body's tissues which in turn can cause long-term damage to vital organs. Moreover, patients can experience significant fatigue from sleep disturbance. This fatigue may create additional problems such as impairment on the job or risk in driving a motor vehicle. Sleep apnea has also been shown to significantly lower life expectancy.
The standard treatment for sleep apnea is to wear a CPAP mask, which improves the opening of the breathing passages by blowing pressurized air into the patient's nose or mouth during inhalation, overcoming the tissue collapse that creates the apnea. Some patients (about 50%) are not able or willing to tolerate the mask. The alternative to CPAP is surgery. Traditionally, surgery has been centered on a procedure known as uvulopalatopharyngoplasty (UPPP), which includes removing the tonsils and trimming the palate. This works about 50-65% of the time to improve the apnea.
It has become clear in the past decade or so that the tissue obstruction also occurs at the base of the tongue in addition to the palate and tonsils. The tongue base obstruction component of sleep apnea may be one of the reasons why surgery on the tonsils and palate alone does not always work. There have been various supplemental surgical procedures that have been devised to address the tongue base component and improve the success of a UPPP.
At MTMC, Dr. William Gross is pioneering the development of the procedure called TORS to address the tongue base component of sleep apnea. Specifically, identifying surgical candidates who have tongue base level obstruction causing sleep apnea, and applying the TORS procedure to correct tongue base obstruction in addition to palate and tonsil obstruction.
Patients are assessed through in-office examination and review of recent sleep studies, MRI of the neck, and sleep endoscopy – a minor procedure where the patient has sleep induced by an anesthesiologist, and then is evaluated with a scope to identify the levels of tissue obstruction. If the tongue base is involved, then the patient is a candidate for TORS for sleep apnea.
The TORS Sleep Apnea procedure involves the surgery and a 2-3 day post-operative hospitalization. The duration of stay is dependent upon the patient's recovery in terms of pain tolerance and reduction of soft tissue swelling. Full recovery is expected to take about three weeks. A post-surgical sleep study is obtained three months after surgery.
Sleep apnea is a serious sleep disorder that occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain -- and the rest of the body -- may not get enough oxygen.
There are two types of sleep apnea:
Am I at Risk for Sleep Apnea?
Sleep apnea can affect anyone at any age, even children. Risk factors for sleep apnea include:
What Are the Effects of Sleep Apnea?
If left untreated, sleep apnea can result in a growing number of health problems including:
In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, as well as academic underachievement in children and adolescents.
Sleep Apnea - Symptoms
The most common symptoms of obstructive sleep apnea (OSA) that you may notice include:
Symptoms of sleep apnea that others may notice include: