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From The Weekend Australian January 5-6 2008 by Pia Akerman
Almost two-thirds of people who undergo surgery for sleep apnoea suffer persistent side-effects and almost a quarter regret their decision to go under the knife.
The findings were made by researchers of the University of Adelaide, whose study, published in the Jan-08 edition of the British Medical Journal, recommends surgery for obstructive sleep apnoea be performed only after a case review by an ethics committee.
Between 2 and 4 per cent of Australians have sleep apnoea, with middle-aged, overweight men the main sufferers, about 24% of them experiencing the condition, which collapses the upper airways during sleep, sometimes stopping breathing.
Treatment usually begins with weight and alcohol management and use of breathing apparatus applying continuous pressure (CPAP mask) while sleeping before surgery is considered.
Adam Elshaug, a lecturer at the University of Adelaide, reviewed reports from around the world, including his own audit of 94 patients in Adelaide.
He found that up to 62% of 21,346 patients who had surgery reported persistent side-effects such as a dry throat, difficulty in swallowing, voice changes and disturbances of smell and taste. Up to 22% regretted having surgery.
“The success rates were relatively low, ranging from 13% for certain procedures, up to 47% for the more advanced procedures,” Dr Elshaug said.
The number of patients undergoing surgery for obstructive sleep apnoea is growing, with 3585 private patients recorded nationally in 2005, up from 3242 in 2004.
Sleep specialists and surgeons agree surgery should not be the first port of call for apnoea sufferers, but say it is a viable option for patients who do not benefit from other treatments.
Sam Robinson, and ear, nose and throat surgeon who works with the Adelaide Institute for Sleep Health, said it was “nonsense” to restrict surgery to clinical trials overseen by an ethics committee.
“Modern reconstructive surgery will give a satisfactory response in 70 to 80% of patients, maybe up to 90%,” Dr Robinson said.