I was diagnosed with Obstructive Sleep Apnea this past month and now I am being referred to an ENT to discuss treatment options.  I have been on thyroid medication for about a month and a half now (I have hypothyroidism).  After my doctor discussed my OSA diagnosis, he told me I also have high blood pressure, a stomach hernia/ulcer and I have a thyroid nodule that appears to be benign but he wants to keep an eye on it.  My question is...will the ENT suggest the CPAP or surgery since I have all the above?  Also I am only 26 years old so maybe thats a factor in deciding.  And should I get the surgery or another opinion if thats suggested to me?  Thank you.

Kim

kkimmy026 wrote:

I was diagnosed with Obstructive Sleep Apnea this past month and now I am being referred to an ENT to discuss treatment options.  I have been on thyroid medication for about a month and a half now (I have hypothyroidism).  After my doctor discussed my OSA diagnosis, he told me I also have high blood pressure, a stomach hernia/ulcer and I have a thyroid nodule that appears to be benign but he wants to keep an eye on it.  My question is...will the ENT suggest the CPAP or surgery since I have all the above?  Also I am only 26 years old so maybe thats a factor in deciding.  And should I get the surgery or another opinion if thats suggested to me?  Thank you.

Kim

Hi Kim,

Most ENTs will suggest surgery, as that is what they do. They are surgeons.

Your age is not a factor in deciding surgery or not. Funny I have heard of at least one incidence of mis diagnosis between hypothyroidism and Sleep Apnoea (on another forum, but many years ago). I believe that symptoms (some) can be similar.

The main thing is to have something done. Hypertension is often linked to untreated sleep apnoea and studies have proven that hypertension readings drop by c.25% and the risk of stroke by c.33% on becoming compliant with cpap.

As to whether to go for surgery or cpap, to me it's a no contest...cpap every time. Reasons as follows: It is 95%+ successful, compliance (long term) rates are good, the effects are terrific, it is non invasive, it is reversible (just stop), successful cpap therapy should help reduce your hypertension and may have a positive effect on the hypothyroidism. In short, you should get your life back and at a mere 26 you can look forward to some good times.

Surgery (of any kind) is risky, even more so with all your conditions, it is not reversible and the long term success rates are pretty poor. In fact if you have severe apnoea, even with successful surgery (if there is such a thing) you will still need cpap.

I had a UPPP in 1994. Unsuccessful and thankfully did not do any serious damage. Been on cpap since. Well worth it.

Kind regards,

Daniel

Interesting, I have hypothroidism and was recently diagnosed with Sleep Apnea.  (Of course, with the thyroid, it is a simple test to see if you have a problem.  Then if you do, a lifetime of taking a daily pill.)

My doctor told me about the alternatives - surgery or CPAP.  For me, no brainer.  Take the CPAP and try it.  You can always do the surgery later.  Plus, according to my doc, the surgery only has a 50% success rate.  Not very good odds.

Sleepy in Michigan

Thanks for the advice.  If this ENT tells me that surgery is the only thing to help...then I am going to get a 2nd opinion.  I am wondering about the CPAP though because I have problems breathing through my nose at night...I mean I have since I was little.  I am just sick of being tired all the time.  Again thanks for the replies.

Kim

kkimmy025 wrote:

Thanks for the advice.  If this ENT tells me that surgery is the only thing to help...then I am going to get a 2nd opinion.  I am wondering about the CPAP though because I have problems breathing through my nose at night...I mean I have since I was little.  I am just sick of being tired all the time.  Again thanks for the replies.

Kim

Hi Kim,

With cpap you don't have to use a nasal mask. Mouth breathers use the full face mask and there are also direct oral interfaces also (oracle). CPAP ain't what it used to be. Mask development alone in the last 6/7 years is unbelievable.

Daniel

I guess SA is diagnosed and treated differently by different doctors.  For me, my doctor screened me for SA and sent me to a sleep lab.  The sleep doctor gave me practically a full physical, including a neurological physical (he is a neurologist).  He looked into my throat.  I told him my doctor said my airways are a little small, he said "a little small? I'd say they are amazingly small"  and he went on to tell me all that is wong with the structure of my airways.  Even so at no time did he even indicate surgery should be attempted.  It was all talk of CPAP from the begining.  And when I did my split night study and was found to have SA, I went home the next morning WITH the equipment.

I suppose if he was a surgeon the story would be different.  I am glad he is not.  I read later that surgery is only 35 to 55 percent effective and it is painful.  CPAP is nearly 100 percent effective if the patient complies.

About your night time nose breathing problem, talk to a sleep doctor or resperatory therapist about this.  I have read that there are oral masks that can be used that allow you to have CPAP treatment through the mouth.

Kim, I was glad to see Daniel and others steering you away from UPPP surgery, if the ENT were to happen to bring that up as an option.

You mentioned this:

Quote:

I am wondering about the CPAP though because I have problems breathing through my nose at night...I mean I have since I was little.

While full face masks or an oral interface can allow mouthbreathing during cpap treatment if a person cannot breathe well through the nose, there is a type of surgery that could make nasal cpap treatment work using more comfortable nasal and nasal pillows masks - IF the ENT finds that you have turbinates that may be rather large.

Check out this link to read some firsthand accounts of experiences with turbinate reduction procedures.  Those topics begin partway down the page - sinus and turbinate surgery discussions:

LINKS to surgery, turbinates, Pillar, TAP experiences

Well I go to the ENT in about an hour.  I will keep all of you posted on what he recommends.  Thanks!!!

Kim

Well I went to the ENT yesterday and he told me that I have a severly deviated septum and a large turbinate growing.  So he recommended surgery to correct those problems.  I have decided to have the surgery.  Thanks for all the advice everyone gave me!!!

Kim

kkimmy025 wrote:

Well I went to the ENT yesterday and he told me that I have a severly deviated septum and a large turbinate growing.  So he recommended surgery to correct those problems.  I have decided to have the surgery.  Thanks for all the advice everyone gave me!!!

Kim

Kim,

The way to go.

Once the swelling goes down you won't know yourself. It should be a big help. Go for another sleep study, in say 3/4 months, post op and you may get a pleasant surprise.

Daniel

I am hoping that you are right on that.  I go on Sept 22 to get the surgery done and they are telling me that I might be off work for 10 days but I am hoping to go back after maybe a week.  

Kim

kkimmy025 wrote:

I am hoping that you are right on that.  I go on Sept 22 to get the surgery done and they are telling me that I might be off work for 10 days but I am hoping to go back after maybe a week.  

Kim

Kim,

Take plenty of time.

I'm not totally up to date on turbinate surgery, but I believe you will have significant swelling and there is a possibility (slim) of bleeding up to 10 days after surgery.

The deviated septum is another story, as he will be straightening out the dividing wall of your nose. There will be swelling, packing and you will feel as if your nose is broken. They will give you plenty of meds to minimise pain.

You will probably speak to the surgeon before he goes to work. Just make sure that he is aware that you don't want him to touch your uvula or soft palate.

Best of luck. Let us know how you get on.

Daniel

I go this friday for the nasal and septum surgery. Before doing this I decided to see an allergist. He agreed with the ENT on the nasal and septum surgery but said before I do the second surgery of having my adnoids, uval, tonsils and soft pallet removed I should atleast get a second opinion. The ENT also found a formation in my voice box that sticks out he want to biopsy it. How long does it take to get results from biopsies? When the ENT was in the back of my throat with the camera there was a flap in the back of my throat that was laying half way closed. He said it needed to be clipped not sure what that is either. Any ideals on what that is?

LightSleeper wrote:

I go this friday for the nasal and septum surgery. Before doing this I decided to see an allergist. He agreed with the ENT on the nasal and septum surgery but said before I do the second surgery of having my adnoids, uval, tonsils and soft pallet removed I should atleast get a second opinion. The ENT also found a formation in my voice box that sticks out he want to biopsy it. How long does it take to get results from biopsies? When the ENT was in the back of my throat with the camera there was a flap in the back of my throat that was laying half way closed. He said it needed to be clipped not sure what that is either. Any ideals on what that is?

Nasal and Septum surgery are fine. Stay away from the other which amounts to a UPPP. The guidelines for diagnosis and treatment of sleep apnoea are available from The Scottish Intercollegiate Guidelines Network at www.sign.ac.uk, the guideline is number73 and runs to about 38 pages.

I'll quote from the guideliine below. The entire guideline is worth a read. I have been unable to come up with anything similar, anywhere else. This guideline, while in use in the UK does form the basis for many other guidelines throughout the world.


[Quote] Effectiveness: There have been two systemetic reviews that concluded there was no RCT evidence supporting the use of UPPP in OSAHS. Uncontrolled case series suggest, at best, a 50% improvement in 50% of patients. The effects on objective measures of OSAHS were poor and largely unpredictable, although statistically significant overall. A meta analysis of laser assisted uvulopalatopharyngoplasty (LAUP) and related procedures should not be used for any severity of OSAHS.
Tonsillectomy is usually carried out in conjunction with conventional UPPP, but may in its own right improve OSAHS. Case series support this conclusion but no RCT data exist.

The presence of large tonsils in a patient diagnosed with OSAHS should prompt referral to an ENT surgeon for consideration of tonsillectomy [end quote].

Based on what your ENT has said, I would be very careful about allowing him to snip anything in your throat. Tonsils and septum are fine, also tubinates.

Biopsy results usually take 3/4 days, as they try to grow the culture first.

Daniel

CPAP is definitely the way to go. UPPP is still radical surgery that has little to any results. I've been on CPAP for 4 years and when used properly, everyday, I feel like a new person. Good luck in your surgery.