Procedure May Help Snoring, Sleep Apnea

A new study bolsters evidence that a simple procedure taking just a few minutes in a doctor’s office can make a big difference for millions of patients suffering from snoring or the related disease of sleep apnea.

The procedure is known as the Pillar Palatal Implant. The study found that 88 percent of patients undergoing the procedure had reductions in their snoring, and nearly two-thirds also reported feeling less sleepy during the day.

More than a third were cured of their sleep apnea. The results were roughly in line with previous studies about the implant's effectiveness.

Insurance and Implant Procedure

Edward Grandi, executive director of the American Sleep Apnea Association, says health insurers should heed the studies and approve reimbursement of the procedure.

“Based on the studies that have come out, it’s certainly as effective, or even more effective, than other surgical techniques,” Grandi tells WebMD. “It should be approved as one more treatment modality.”

Sleep apnea and loud persistent snoring are two of the most common sleep complaints. Left untreated, sleep apnea can lead to major health problems such as heart disease, high blood pressure, and stroke. People with the disorder often snore, but not all snorers have sleep apnea.

Sleep apnea that is caused by partial airway collapse is often due to weakening of the muscles of the soft palate; it results in episodes in which a person is unable to take a breath. Sleep becomes disrupted and daytime sleepiness becomes a consequence. Palate movement, or "palatal flutter," causes vibration, which results in snoring.

How the Implant Works

The new treatment reduces the movement or vibration of the soft palate with implants designed to stiffen it. Using a special needle, three pieces of polyester mesh are inserted into the soft palate near where it meets the hard palate.

Although considered a surgical procedure, implantation takes only about 10 minutes and is done under local anesthesia in a doctor's office.

The implants are designed as an alternative to a surgical process known as uvulopalatopharyngoplasty (UPPP) and to a nonsurgical treatment known as continuous positive air pressure (CPAP).

CPAP -- the most common nonsurgical treatment -- is a breathing machine that helps push air in and is delivered by mask when sleeping. UPPP -- a painful surgical process -- has a reported success rate of 40 percent.

“There are millions of people in the earlier stages of snoring and sleep apnea,” researcher Michael Friedman tells WebMD. “They’re not willing to accept the burden of sleeping with this machine every night and they want to avoid surgery.”

Comparing Treatments

Friedman studied 125 patients who had undergone the implant procedure alone or in some combination with nasal surgery and UPPP. Noting that airway blockage can stem from the nose, the palate, or the base of the tongue, he found the procedure was somewhat more effective in patients where the cause was limited to the palate. With additional sources of obstruction, additional procedures are needed, he says.

Although doctors can’t always be sure which treatment is best, the implants are such a simple procedure that “if there’s any benefit at all, I don’t see why you wouldn’t do it,” says Regina P. Walker, MD, associate professor of otolaryngology at Loyola University Medical Center.

The spread of the implants has been slowed by its price tag, upwards of $2,000. John Foster, senior vice president of implant maker Restore Medical, said he expected health insurers to begin reimbursing the procedure in one to two years, after more studies on the implants are completed.

The implants were approved in January 2003 for snoring and September 2004 for sleep apnea. The primary complication reported was the implant inappropriately coming out -- with those partially out needing removal and replacement.

By Richard Sine, reviewed by Louise Chang, MD

Sources: Friedman, M. Otolaryngology—Head and Neck Surgery, February 2006; vol. 134: pp 187-196. Michael Friedman, MD, FACS, chairman, head and neck surgery, department of otolaryngology and bronchoesophagology, Rush Medical College, Chicago. Edward Grandi, executive director, American Sleep Apnea Association. Regina P. Walker, MD, clinical associate professor, department of otolaryngology, Loyola Medical Center, Maywood, Ill. B. Tucker Woodson, MD, chief, sleep medicine, Medical College of Wisconsin, Milwaukee. WebMD Medical News: “Implants Help Snorer’s Sleep.”