Surgery Has No Clear Benefit For Sleep Apnea

Surgery should not be the first treatment for a patient who suffers from obstructive sleep apnea - when the upper airway during sleep collapse - after a article in the British Medical Journal (BMJ) , the theme of this week .

Obstructive sleep apnea, a common disease that causes loud snoring. Sometimes the people with this disease can be completely breathing for a short time during his or her sleep. Affected are mostly middle-aged, overweight men, and can be reached by car crashes and reduces health related to the quality of life, the authors explain.

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

Dr. Adam Elshaug, University of Adelaide, Australia, and the team conducted an investigation. It analyses the latest evidence of the upper airway surgery. The results showed that the evidence for the benefits of the operation is unclear.

One of seven randomized trials showed that the operation had a very limited effect on the symptoms. Even where the quality of life showed some improvements, hardly showed that this improvement lasted longer than one or two years.

A review of 48 studies showed that 62% of patients who undergo surgery for obstructive sleep apnea had suffered lasting negative effects, including difficulty swallowing, voice changes, smell and taste disorders and dry throat.

The researchers explain that weight loss and other lifestyle changes are recommended in combination with CPAP. However, they are difficult to reach. The surgical 'cure' may be attractive because CPAP therapy, the patient must compliance with the instructions - CPAP, the benefits for the patients seem to be inconclusive.

Nevertheless, as the evidence of a clear benefit from the operation is missing, and the risk of adverse effects (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 the surgery, and the possible side effects, should be used for the patient.

"Upper airway surgery should not for the first-line treatment of obstructive sleep apnoea in adults"

Adam G Elshaug, John R Moss, Janet E Hiller, J Guy Maddern

BMJ , 2008; 336:44-5 doi: 10.1136/bmj.39381.509213.AE

Written by - Christian Nordqvist

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