What are my options to treat sleep apnea, and how effective is sleep apnea treatment?

Doctor's Answers 1

thanks for the D2D.

Please refer to my reply on “How to treat sleep apnea without CPAP or surgery?” for conservative first line measures to treat sleep apnea. Additionally, surgical measures may be needed when these conservative modalities do not suffice, or if the patient cannot tolerate the CPAP mask or prefer a surgical option.

What I have found to be most importantly, is to tailor treatment for each patient’s medical and anatomical condition, preferences, needs and comfort level. A multidisciplinary and multilevel approach is often needed. There is really no one best treatment, with even patients having the same severity of sleep apnea and sites of obstruction needing different treatment.

Surgery may be needed to correct a deviated nose septum bone, reduce inferior turbinates by actual trimming or radiofrequency or coblator reduction of size; or strengthen weak and collapsible nasal valves.

Even if a CPAP still needs to be used for severe sleep apnea post nasal surgery, establishing an open nasal airway is important to reduce mouth breathing, as mouth breathing inevitably allows the tongue to fall backwards in sleep and further obstruct breathing. A nasal surgery is sometimes needed thus, to allow CPAP ease of use.

If very large tonsils are the only cause of the sleep apnea, tonsil removal surgery is a simple surgery that will cure the sleep apnea. If the soft palate is low lying or medialised, it may require realignment through a uvulopharyngopalatoplasty (UPPP) surgery.

Nowadays, there are many modifications to UPPP that allow less complications and better results (like uvulopalatal flap and lateral pharyngoplasty). Should the base of tongue and its lymphatic tissue be bulky, radiofrequency or coblation reduction surgery may be helpful, but these procedures may need to be repeated several times to be effective.

Other surgery are usually 2nd line, as there are more complications. Careful selection of the patients after comprehensive counselling of pros and cons would be important.

For example, to reduce a large base of tongue prolapse, tissue removal of the midpart of the tongue may be needed (like median glossectomy), or skeletal advancement methods to prevent the tongue from falling backwards in sleep is needed (like inferior saggital mandibular osteotomy and genioglossus advancement and hyoid surgery).

Patients with receded lower jaw and midface may need skeletal maxillomandibular advancement surgery. This would require dental reorganisation too, and a more morbidity. If the CPAP is able to treat the OSA, most patients nowadays do not opt for the more complex surgical interventions.

Ongoing research into an implantable hyperglossal nerve stimulator for moderate to severe sleep apnea is ongoing for patients that have failed CPAP therapy. This maintains upper airway patency by augmenting the neural drive supplying the throat pharyngeal dilator muscles. It is not approved for use in Singapore yet.

Similar Questions

How does one differentiate normal snoring from sleep apnea?

Thanks for the D2D. Snoring is not just noise. Not all who snore have sleep apnea, but snoring is a sign that you may have sleep apnea. In Singapore, a recent study found that 90% of those with already moderate to severe sleep apnea did not know that they had sleep apnea! Sleep apnea happens when there is a block in the airway that results in significant oxygen desaturation in the blood. To differentiate snoring from sleep apnea, a definitive sleep study is needed.

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How much does sleep apnea treatment cost in Singapore?

Thanks for the D2D. Here are some cost estimates for sleep apnea treatment in Singapore: The initial cost would be the consultation (from $150) and possibly a flexible nasoendoscopy cost (from $250) to determine the levels of obstruction and medical issues that need to be managed holistically. A sleep study is usually needed (from $500 depending on type needed). The costs thereafter would really depend on what type of treatment is, depending on the cause and severity of sleep apnea. Example, medications, CPAP machines, surgery – the cost would differ widely.

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