10 Tips on Finding the Right Surgeon For Your Sleep Apnea
Sleep Apnea SurgeryFinding the right surgeon for you can be a challenge in any situation, but finding the right sleep apnea surgeon can be even more challenging since there are so many different procedures and there are no standard operations. I'm asked quite often by people in other states or other countries who they should go see to treat their sleep apnea condition, and over the years, I've come up with the following 10 thoughts and tips. These are suggestions that I would offer to a friend or relative in a remote state if they asked for my advice.
In most cases, an ENT surgeon will be the most appropriate person to see, as they are most qualified to perform surgical procedures of the upper airway. By definition, ENTs (otolaryngologists) are trained in plastic and reconstructive surgery of the soft tissues of the head and neck region. They are the specialists that other doctors call to manage complications of the upper airway. However, there are situations where oro-maxillo-facial surgeons and general plastic surgeons may also play a role.
1. Did you exhaust every other possible option for sleep apnea? Did you try CPAP? How much effort did you put into making sure you gave CPAP a chance to work? Did you consider dental appliances? A good surgeon doesn't rush into surgery without trying conservative options first.
2. Can you breathe through your nose? Having a stuffy nose can definitely prevent you from benefitting from either CPAP or dental devices. Often, after optimizing nasal breathing via medical or surgical means, people are able to use CPAP or dental devices more effectively.
3. Make sure the surgeon is confident to a reasonable degree where your obstruction is happening. Performing major surgery to "see what happens" is not a reason to do surgery. There are three major areas: the nose, the soft palate and the tongue. The surgeon must be comfortable operating in all three areas. How thoroughly do they examine your upper airway? Do they look with the fiberoptic camera with you sitting up and lying flat? Do they look for movement of the space behind the tongue by having you thrust your lower jaw forward?
4. Can they give you their success rates and complication rates? What is their definition of success? What are their long-term success rates?
Compare this with current success rates for uvulopalatopharyngoplasty (UPPP), which has published success rates around 40%. Multilevel surgery approaches around 75 to 80%.
Can they honestly give you their complication rates? If they have no complications whatsoever, I'd be suspicious. Are they prepared to handle anything that may arise? Ask what his or her last complication was and how it was managed. It may seem counterintuitive, but if they don't have any experience managing complications, you don't want to be the first one.
5. Do they have a plan in case the surgery doesn't work as planned? If the post-op sleep study shows less than a significant drop in the AHI score, what are your options? This should be discussed before your initial surgery. Do you stop there, or do you go back and do more (if there's an obvious area to address), or do you go back to CPAP? Is a referral to an oro-maxillofacial surgeon an option?
6. Don't focus too much on volume of cases. What's important is how well it's done and the appropriate location of the procedure, rather than total number of cases performed. Thousands of UPPPs alone are performed every year by surgeons with only a 40% success rate. If this is the only operation that's offered, without a plan to address the tongue either simultaneously or at a later point, then your chances of success is no better than 40%.
7. Do they use the Friedman staging system? This is a simple screening tool where by looking at the size of your tonsils and your tongue position, you can predict whether or not a UPPP alone can have an 80% chance of success. Most people will fall into the "unfavorable" category, but if you meet the "favorable" criteria, a UPPP alone may be a good option, as long as you understand that there's still about a 20% chance of failure.
8. How comfortable are they performing tongue base procedures? Do they have experience with multiple procedures or are they very good at just one? Are they able to perform any of the minimally invasive tongue base procedures in addition to the standard techniques?
9. How well do they work with your sleep doctor and/or dentist to coordinate your care? Is he or she willing to combine multiple treatment options if necessary? Sometimes dental devices or surgery can make CPAP more tolerable by lowering the necessary pressure.
10. Do you trust your surgeon? You must be comfortable and have a good rapport before you undergo any invasive procedure. Get second or third opinions. No matter how technically skilled the surgeon is, if there's no bedside manner or if the staff is rude, it will eventually show in the quality of your care. As with any doctor, the focus must be on you as a whole person, rather than an isolated surgical procedure.
As you can see there's no one best solution for treating sleep apnea. There are general recommended guidelines and conservative options must be tried before surgery, but even with surgery, many different paths can be taken, since every patient is different with individual needs. If you're considering surgery, find someone that you're comfortable with, and develop a good relationship with that surgeon.
Now that you know how to find the right surgeon, how do you know if you're choosing the right treatment option? For a free report on "The Truth About Obstructive Sleep Apnea Surgery," go to http://www.thetruthaboutosasurgery.com. Dr. Steven Y. Park is an otolaryngologist and author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. It was endorsed by New York Times best-selling authors Christiane Northrup, M.D., Dean Ornish, M.D., Mark Liponis, M.D., Mary Shomon, and many others. http://www.sleepinterrupted.com