Use of Air Pump Preferred Over Surgery for Treating Apnea
The use of a nighttime air pump is the preferred therapy for sleep apnea because of questions about the safety and effectiveness of surgery, according to a new review of previous studies.
The reviewers, led by Supriya Sunduram of Norfolk and Norwich University Hospital in England, conclude that despite widespread use of surgery as a means of improving sleep quality, it should not be recommended because of "uncertainty surrounding its safety, continued effectiveness and inconsistent" results.
The updated review of studies appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The review, covering eight randomized controlled trials involving 412 individuals suffering from mild to severe obstructive sleep apnea, also notes that there is a lack of evidence about the long-term outcomes or complications of those undergoing surgery.
People who have apnea stop breathing repeatedly during sleep, sometimes hundreds of times a night and often for a minute or longer. In each case, the brain is aroused to restore normal breathing. The end result is fragmented sleep of poor quality.
Obstructive sleep apnea is caused by airway blockage, commonly when the soft tissue in the rear of the throat collapses during sleep. In central sleep apnea, the airway is not blocked, but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the two.
The use of a continuous positive airway pressure (CPAP) machine is the most common treatment for sleep apnea. CPAP machines pump air to a mask worn over the nose or mouth or both. Air pushed into the breathing passages at a high enough pressure will keep them from collapsing.
Several surgical procedures are used to alleviate apnea. The most common is removal of the uvula and some of the soft palate at the back of the roof of the mouth to increase the size of the airway. Tonsillectomies and adenoidectomies often are done in conjunction with the procedure to further enlarge the airway. Other procedures target other parts of the upper airway. Some are laser assisted.
The studies that were evaluated variously compared surgical procedures with CPAP, with other conservative management regimes and with one another. Conservative management options include weight loss programs, modifications of the patients' sleep positions, medications to relieve nasal obstruction and avoidance of evening alcohol and hypnotics.
"The studies assembled in the review do not provide evidence to support the use of surgery in sleep apnea .... as overall significant benefit has not been demonstrated," the authors write.
Sleep apnea affects more than 12 million Americans, according to the National Institutes of Health. Risk factors include being male, overweight and over age 40, but sleep apnea can strike anyone at any age, even children. The vast majority of cases remain undiagnosed and untreated. Sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotence and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes.
Doctors who favor surgery argue that most people who use the machine do not do so properly or consistently and that surgery is a "cure.".
Others argue that the solution lies in better educating and supporting CPAP users because only 2 percent of people with apnea have anatomical abnormalities that would be removed by surgery and that there are always risks to having an operation.