CPAP is a highly effective treatment for sleep apnea, when people use it. Unfortunately, many people just don’t use it. Studies show that generally less than half of people prescribed CPAP actually use the treatment long-term. Not using CPAP means that these people still have untreated sleep apnea, which is a potentially deadly condition.
So it’s no surprise that people are often looking for an alternative to CPAP. Nor is it a surprise that people promoting sleep apnea surgery say it is an alternative. But it isn’t.
Studies show that people who receive recently-developed minimally invasive surgery still have significant sleep apnea and still need treatment. On the other hand, oral appliances tend to fully eliminate sleep apnea.
Recently, doctors have started promoting more minimally invasive surgical techniques to help people overcome sleep apnea. The goal is to suspend your airway further forward to help expand your airway so that you can breathe easier. Surgeons do this by putting stitches around your hyoid bone, holding it forward. This should create extra space in the airway, reducing or eliminating sleep apnea.
However, actual studies show it doesn’t actually eliminate sleep apnea. In one study, the surgery reduces a person’s AHI (apnea-hypopnea index, a measure of sleep apnea) from 40 to 22. This is a reduction from severe to moderate sleep apnea, but moderate sleep apnea is still dangerous and needs treatment. People need to reduce their AHI below 15 to significantly reduce their risk, although even lower is better.
Another surgical technique being promoted is a less invasive form of traditional surgery reducing the volume of mouth and throat structures (like the uvula and tongue) to expand the airway. Preliminary trial results for this surgery were published just last week. They show patients saw their AHI reduce from about 50 to 20, again from severe to moderate. In addition, there were two serious complications among the surgery patients.
Neither of these treatments can eliminate the need for further sleep apnea treatment.
On the other hand, oral appliance therapy can be very effective and does work as a true CPAP alternative. In one review of 11 studies comparing CPAP and oral appliances, oral appliances reduced AHI below 15 in every study. Although this is still considered mild sleep apnea, it isn’t associated with risk for serious complications from sleep apnea. Apnea at this level is considered treated.
In addition, when given a choice between CPAP and oral appliance, people chose an oral appliance 80% of the time. This might make an oral appliance the best treatment for sleep apnea.
If you have sleep apnea and can’t adapt to CPAP, we can help. Don’t just stop using your CPAP: find a true alternative that resolves your sleep apnea.
By Ryan M. Clancy, DMD, MAGD, LVIF, FPFA, FIAPA | September 9th, 2020 | Sleep Apnea
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