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Thursday, 4 January, 2001, 01:49 GMT
Sleep surgery 'unlikely to work'
snoring operation
Operations to correct snoring are potentially hazardous
Going under the knife - or laser - to try to solve either snoring or sleep apnoea will probably not work, say Spanish doctors.

Some ear nose and throat specialists recommend the use of surgery to physically enlarge the upper airways.

Most ENT specialists in the UK are very cautious about operating on people who might have obstructive sleep apnoea

Professor Peter Calverley
But the latest study team has carried out scans of the airways of dozens of sleeping volunteers - and found the problems may have less to do with an abnormal shape, and more with the way they work.

This means having surgery to try to correct either antisocially loud snoring - or more dangerous conditions such as obstructive sleep apnoea (OSA), in which the airways are temporarily blocked - could mean the patient enduring a great deal of discomfort for no improvement.

The scientists, from the university hospital in Valencia, deprived their volunteers of sleep for 20 hours, then allowed them to doze off inside a magnetic resonance imaging (MRI) scanner.

The scans revealed the aperture of a structure in the throat called the velopharynx.

They found that in sleep apnoea patients, the variation in the potential aperture was much greater than in normal patients.

This means any procedure to permanently increase the aperture through surgery would be unlikely to be effective.

A sleep apnoea expert, Professor Peter Calverley, a professor of pulmonary medicine and rehabilitation, and a former chairman of the British Sleep Society, said surgery on the upper airways tended to have a poor success rate.

He said: "A recent study of one ENT group showed that in only 45% of patients, surgery had been worthwhile.

"The problem is that doctors will always try to help, even if the problem is intractable.

"It's very tempting to do an operation and hope that something goes well.

'Most cautious'

"Most ENT specialists in the UK are very cautious about operating on people who might have obstructive sleep apnoea.

"They recognise that this is both hazardous and often ineffective."

It is estimated as many as 1% of the population may be suffering from OSA.

It happens while asleep because it is natural for muscles to have less rigidity and tone while in this condition.

This can lead to the shape of the airway "collapsing", causing a blockage and depriving the lungs of air.

It can often lead to poor quality sleep as the body is forced to wake up slightly, many times an hour, so that the muscle tone is restored and the airway reopened.

This can lead to dangerous levels of over-tiredness during the daytime.

Non-surgical treatments are few, although trials of continuous positive airway pressure, in which a mask is worn to force air through the airways into the lungs, have proved beneficial in many cases.

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