"It's funny when you feel as if you don't want anything more in your life except to sleep, or else to lie without moving..." (Jean Rhys)
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Article #4

Patient Selection and Surgical Results

in Obstructive Sleep Apnea

Audience Comment:
One reader comments that 3-5 month follow-ups after surgery show "nothing" when 3-6 years follow-up is really what he wants to see. Surgery is not supposed to be a "short-term treatment" for sleep apnea.
My Response:
Certainly no one undergoes surgery with the idea of getting relief for only a matter of months. In fact, people with sleep apnea--like myself--who go for surgery expect a "cure" which will leave them never having to use CPAP or worry about the condition again, just as a person who has an appendectomy doesn't expect to have another bout of appendicitis later in life. This may be an unrealistic expectation that could result in recurrent sleep apnea going dangerously unrecognized years later.
The expectation breaks down when you realize that obstruction to breathing can occur--or develop--in more than one part of the airway. Here it becomes especially relevant that removal of one obstruction can put extra stress on another part of the airway which may then collapse.

Another Audience Comment:
I, too have had UPPP laser surgery which resulted in worsening of my condition. Eight years have passed since the surgery and my condition continues to worsen! My BiPAP settings have gone from 10-5 to the recently increased pressure of 16-10. I have had a 40 pound weight loss over the eight years. I'm wondering why I am getting worse. I am a 43-year-old female.
My Response:
This sad story illustrates the point that surgery for sleep apnea can at times make the problem worse. Such was my experience. It also calls into question the old sop about losing weight, since this lady lost 40 pounds even as her condition worsened. Evidently she is using her CPAP, so that makes three standard treatments that have failed her. Personally, I can't answer her question; but, unlike too many clinicians, I do not hasten to find some explanation that will put most of the blame on her for the failure of our therapeutic approaches! Sometimes the most successful of treatments simply don't work and we don't know why. In fact, it is rare to find a treatment 100% effective.

Do you have your own comments to add to discussions above? E-mail me at

kerrinwh@ix.netcom.com

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