A new operation may provide relief for people who can’t get a good night’s sleep because of repeated pauses in breathing.
This condition, called obstructive sleep apnea, occurs when the upper part of the throat narrows and closes during sleep, causing snoring and interrupted breathing. Older obese men are more likely to develop sleep apnea.
Treatment may include weight loss or a special mouthpiece or continuous positive airway pressure machine to keep the breathing passages open. Surgery to remove excess tissue from the throat may also be helpful.
Dr. Michael Friedman, chairman of sleep surgery at Rush University Medical Center in Chicago, recently compared two “minimally invasive” surgical techniques that don’t involve large incisions. Both use radio-frequency energy to reduce the volume of tissue at the base of the tongue without destroying surrounding tissue.
The current standard technique — RFBOT (radio-frequency reduction of the base of the tongue) — shrinks tissue, while a new procedure — SMILE (submucosal minimally invasive lingual excision) — “melts” and then suctions it out. “You can shrink tissue only so much, but if you can’t remove it, you really can’t accomplish a major reduction,” Friedman says.
His study involved 96 patients, 48 of whom underwent SMILE and 48 of whom underwent RFBOT. Results showed SMILE had a 65 per cent success rate compared with 42 per cent for RFBOT.
However, SMILE patients reported more pain and had more complications than RFBOT patients. Many SMILE patients experienced minor bleeding and six had significant swelling. No RFBOT patients experienced either complication. Friedman and his colleagues speculate that SMILE’s higher complication rate may have occurred because doctors were still learning the new procedure.
“The biggest message is that there are options,” Friedman says, explaining that many people with sleep apnea are unwilling to choose a treatment such as continuous positive airway pressure, which involves wearing a breathing mask during sleep.