Surgery Has No Clear Benefit For Sleep Apnea

Editor's Choice
Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Respiratory / Asthma;  Ear, Nose and Throat;  Obesity / Weight Loss / Fitness
Article Date: 04 Jan 2008 - 0:00 PDT

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Surgery should not be the first treatment for a patient who suffers from obstructive sleep apnea - when the upper airways collapse during sleep - according to an article in the British Medical Journal (BMJ), this week's issue.

Obstructive sleep apnea, a common disorder, leads to loud snoring. Sometimes the person with this disorder can stop breathing completely for short period during his/her sleep. It mainly affects middle-aged, overweight men, and is linked to car crashes and reduced health-related quality of life, the authors explain.

Although guidelines recommend CPAP (continuous positive airway pressure), combined with weight control and alcohol management, upper-airway surgery is becoming more popular as the first line of treatment.

Dr Adam Elshaug, University of Adelaide, Australia, and team carried out an investigation. They analyzed current evidence for upper-airway surgery. Their findings showed that the evidence for the benefits of surgery unclear.

One of seven randomized trials showed that surgery had very limited impact on symptoms. Even where quality of life showed some improvements, hardly any showed that this improvement lasted more than one or two years.

A review of 48 studies showed that 62% of patients who had undergone surgery for obstructive sleep apnea suffered persistent adverse effects, including difficulty in swallowing, voice changes, smell and taste disturbances, and dry throat.

The researchers explain that weight loss and other lifestyle changes are recommended in combination with CPAP. However, they are difficult to achieve. The surgical 'cure' may seem more attractive because CPAP therapy requires the patient to adhere to instructions - also CPAP's benefits to patients appear to be inconclusive.

Nevertheless, as the evidence of a clear benefit from surgery is lacking, plus the risk of adverse side effects (from surgery), guidelines recommend CPAP as the first line of treatment.

The authors write that surgery for obstructive sleep apnea should be carried out within controlled clinical trials. Information about the inconsistent results of surgery, plus the potential side effects, should be provided to the patient.

"Upper airway surgery should not be first line treatment for obstructive sleep apnoea in adults"
Adam G Elshaug, John R Moss, Janet E Hiller, Guy J Maddern
BMJ 2008;336:44-5 doi:10.1136/bmj.39381.509213.AE
http://www.bmj.com

Written by - Christian Nordqvist
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