Sleep Blog

Sleep disorder and ear, nose and throat specialists at Thomas Jefferson University here in Philadelphia are examining a new (they call it “innovative”) procedure to treat obstructive sleep apnea syndrome.

At first blush, the press release issue sounds like something everyone with apnea may want to celebrate as a possible cure somewhere down the road. After reading the full press release, though, it sounds like this is a horror story come-to-life.

A press release issued by Jefferson University, the procedure, says that during the Genial Bone Advancement Trephine (GBAT) procedure, a small portion of the lower jaw which attaches to the tongue is moved forward, pulling the tongue forward, out of the back of the airway, which increases the airway space.

According to the press release, the GBAT is considered an option for patients when medications or an xPAP device, such as a continuous positive airway pressure (CPAP) device or a bi-level positive airway pressure device, commonly known as a BiPAP, have proven to be, in the wording from the press release, “ineffective.”

Many people who say an xPAP is “ineffective” give up after but a few days of use, and at that, just mere hours, sometimes less than six hours, logged on the xPAP device. A large part of the “ineffectiveness,” though, can often be traced to a lack of support, from physicians, the home health care company providing the equipment, family, or other sources.

“Even immediately after the procedure patients have an easier time breathing,” says Maurits Boon, M.D., clinical instructor in otolaryngology-head and neck surgery at the Jefferson Medical College of Thomas Jefferson University. “We have also observed that in a select group of patients hypertension (high blood pressure) drops off.”

Continuing, the press release notes that the “procedure is often employed as an adjunct to more conventional surgery and can be very effective at treating” obstructive sleep apnea.

Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. Obstructive sleep apnea occurs when there is collapse of upper airway structures that prevent normal airflow. This essentially, results in cessation of breathing with resultant decreases in oxygen in the blood stream. The consequence is that this pattern of breathing causes interruptions in the normal sleep cycle and makes it difficult to get a restful night of sleep.

“Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood,” says Karl Doghramji, M.D., director of Jefferson University Hospital’s Sleep Disorders Center.

“Sleep apnea occurs in all age groups and both genders,” said Dr. Doghramji, a professor of psychiatry and human behavior at Jefferson. “It is more common in men, although it may be under-diagnosed in women.”

Early recognition and treatment of sleep apnea is important, as it may be associated with:

• irregular heartbeat
• high blood pressure
• heart attack
• stroke

During the GBAT procedure, a small window is made in the lower jaw and advanced forward, according Dr. Boon, quoted in the press release. Because the tongue is attached to this portion of the jaw, it effectively moves the tongue forward to open the airway.

The surgeon is able to go through the inside of the mouth, avoiding the need to make any external incisions and avoiding any cosmetic changes. The procedure is usually done in conjunction with an uvulopalatopharyngoplasty (emphasis mine) surgery used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate — and often a “trim” of the tongue, which the press release did not include).

The piece of bone along with the attachment for the tongue is pulled forward and down, then fastened to the outside of the lower jaw. A small titanium plate is used to affix the bone.

The patient may experience soreness but will not have any change in dental occlusion (the way the teeth fit together), said Dr. Boon. The recovery period is usually about two weeks.

Three to six months after the procedure, follow-up sleep tests are performed.

When I was reading the press release the first time and saw the comment that the “procedure is often employed as an adjunct to more conventional surgery and can be very effective at treating” obstructive sleep apnea, my skin literally crawled. The first thought that went through my mind was, “For God’s sake, tell me this isn’t talking about the UPPP (uvulopalatopharyngoplasty). Please! Sadly, it was, as you clearly see above.

I have no idea who Jeffrey A. Baxt is, his background, nor what he knows about apnea, what someone mentioned to him, or what he may have read on the Internet, especially on one of the many ear, nose, and throat (ENT) specialist sites hawking — much like a dead fish — the UPPP procedure as a way to “help” apneics” treat their apnea. I really feel sorry for Baxt, but, moreso, I would strongly suggest he learn about it in-depth. Perhaps, if he feels so strongly about it and about its safety, he would be willing to undergo the procedure, just for grins and giggles, but moreso, to demonstrate its efficacy and lack of long-term issues.

In a post I made on July 15, 2007, about various comments made by Nancy Grace on her TV show, dismissing sleep apnea as a serious health issue, I wrote the following about the UPPP procedure:

Some physicians, particularly some Ear, Nose, and Throat (ENT) specialists, that believe — and actually tell their patients — they can “cure” or “successfully” treat sleep apnea through a procedure that removes all the soft tissue, the uvula, and slices of the back of the tongue. That procedure, a tongue-twisting 25-letter word — uvulopalatopharyngoplasty (commonly called a UPPP, a UP3 (spoken as You-Pea-Three) — is a fairly torturous one for the victims. Many of the people who have undergone the procedure that I know, probably close to around 100 people from various parts of the U.S., all tell similar horror stories.

Among the many issues of individuals who have undergone the UPPP are:

• cannot drink through a straw (the tissues to help create “suction” in the mouth and throat are no longer there)
• need “touch-up” procedures, or mini-versions of the UPPP, basically, every couple of years at the surgical site
• can never use a nasal mask with a CPAP or bi-level (BiPAP) machine ever again — when they need to begin using the air generators to treat their apnea when it returns. In over 90 percent of the people who have undergone the UPPP that I know, they have all had to return to CPAP or BiPAP (generically called xPAP) within two-to-three years. Individuals from the other 10 percent (or so) have also told me they suspect they need to be using a CPAP or BiPAP again, but they have not undergone a sleep study or titration study to determine the need or correct pressure. Most of those people have told me they also will not undergo a new sleep study or titration study because they were assured by the ENT prior to the UPPP procedure they would never again need to use an xPAP machine after the UP3 / UPPP procedure! It is the frustration of having been lied to about “a cure” for their ailment, sleep apnea, that is hindering them, basically.

According to statistics released by Stanford University, the UPPP procedure is effective in less than 40 percent of its victims.

While reading the stats from Stanford, be sure to read up on the associated risks of this “more conventional” surgery that is tied into the “effectiveness” of the GBAT.

There are but a few who have had benefits from the UPPP when looking at all who have undergone the UPPP procedure. The majority will argue — after the fact — that it seems the ENT performing the UPPP procedure was more interested in buying a new Lexus than in actually working to eliminate the apnea. The UPPP is, by far, not a procedure to treat apnea.

During a meeting I attending in 2002, Dr. Joan Hendricks of the Veterinary Hospital of the University of Pennsylvania explained that the UPPP was originally designed by a veterinarian to treat problem snoring in his dog.

While the UPPP may, in mild cases of apnea, reduce the apneas and perhaps eliminate most, and sometimes all of the snoring, the problem is that this is not permanent. People have to go back for “touch-ups” to get rid of the snoring again. They must also undergo routine sleep studies to monitor their apnea status, as once it returns, it needs to be treated, or, you guessed it! — they must undergo the knife — again — for another UPPP procedure.

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