Patients with heart failure, underlying heart disease, or claustrophobia symptoms may feel short of breath on CPAP. Many of these patients have difficulty tolerating more than 10 cm water pressure, which worsens symptoms and may cause central apneas. Use of a full face mask to allow oral breathing while falling asleep and a repeat sleep study may be beneficial.
Explore This IssueNovember 2006
“For hard-core patients who will not or cannot tolerate CPAP, minimally invasive surgical procedures can be helpful. If snoring is the major complaint, surgeries of the tongue base, palate, and/or nose may be beneficial,” Dr. Friedman said. If a nasal abnormality is present, sometimes just treating the nose can resolve the apnea and improve compliance.
There is growing evidence that nasal blockage is associated with poor CPAP compliance, stated Edward M. Weaver, MD, MPH, Associate Professor of Otolaryngology and Surgical Program Director of the Sleep Disorders Center at the University of Washington School of Medicine in Seattle, WA.
“Emerging research and experience suggest that surgery correcting nasal obstruction will improve CPAP compliance,” Dr. Weaver stated.
According to Dr. Friedman, the Pillar procedure, which stiffens the palate via three injections, can eliminate palatal snoring in 80% of patients with mild disease, and reduce apneas and hypopneas. If the Pillar procedure is effective, patients do not need CPAP. Patients who fail to be cured by the Pillar procedure may be better able to tolerate CPAP, Dr. Friedman said.
“Doing nothing is not an option, unless the patient has mild sleep apnea. The biggest disservice sleep physicians can do is to tell patients their choices are to use CPAP or go untreated. I’ve seen patients who were never told there were other options,” Dr. Friedman stated.
©2006 The Triological Society