An Operation Obsession

More alarming, the remaining 60%, who showed no such reduction in their Respiratory Event Indices, actually averaged an increase from 17 to 27!

Moreover, these patients reported no significant improvement in symptoms 3-4 years after surgery.

As those who have read other of my writings may know, my own experience lends dramatic support to these findings. After my first surgery, my own Index doubled, from the 20's to the 40's. After my second surgery, it doubled yet again, from the 40's to the 80's!

The explanation for worsening of apnea after surgery--and possibly reduced responsiveness of apnea to CPAP as well--requires discussion in a separate article, yet to be written. What I want to focus on here is an explanation for why patients with sleep apnea might read such a finding yet disregard it.

For one thing, to give them credit for some rationality, they get misled by reports that this or that "new" procedure offers better results. Alas, as the UPPP becomes more widely discounted, there seem to evolve a myriad of other procedures going by names which evade the bad reputation of UPPP--often cryptic and misleading names like LAUP (laser-assisted uvulpalatopharyngoplasty). All of these "minor" procedures suffer from the main defect of UPPP: they address mainly just obstruction in the upper part of the airway--the nasal passages and the outlet from mouth to pharynx as it is constrained by structures like the uvula, soft palate, and tonsils. However, it appears that most people with obstructive sleep apnea have multiple areas of actual or potential obstruction, and relieving one obstructed area higher up and more accessible to surgery may only bring out an obstruction lower down, especially at the base of the tongue, which presents real problems for surgical remedy. There are procedures that have proven effective, even as effective as CPAP and in treatment-resistant cases as well, like the bilateral maxillomandibular osteotomy and advancement developed at Stanford. However, this procedure is neither minor, inexpensive (even with insurance), nor widely available.

Setting aside the apnea sufferer's natural confusion about these "new and different" operations, I still observe a stubborn attachment to a surgical solution in many, even in the face of clear evidence against it.

What lies behind this is often described as "inability to tolerate CPAP." All too often, however, this global phrase conceals specific problems, such as claustrophic reactions to the mask, air leaks, etc., which have a variety of potential solutions. More details about

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