A cutting edge treatment for patients with obstructive sleep apnoea, involving shrinking the tongue and reshaping the palate, is being put to the test in a new study led by the Adelaide Institute for Sleep Health (AISH) at the Repatriation General Hospital (RGH).
The new surgical technique, pioneered by former Flinders Medical Centre (FMC) surgeon the late Dr Sam Robinson, offers a potential cure to patients who fail to benefit from existing remedies, including Continuous Positive Airway Pressure (CPAP) therapy – currently the gold standard treatment.
The study follows a pilot last year, which saw the technique trialled on 48 patients at FMC and the Illawarra ENT Head and Neck Clinic in NSW.
As reported by Southern Health News in April 2013, the treatment cured 70 per cent of the patients.
The new study will involve about 100 patients and marks the next phase in the Institute’s work to make the surgery available to patients as an additional therapeutic option.
The new procedure, co-designed by FMC Surgeon Dr Eng Ooi and Flinders University Professor Simon Carney, combines several existing surgical techniques which - when carried out in isolation – offer limited relief.
Project Lead and AISH Clinical Director, Associate Professor Nick Antic, is hopeful that combining the techniques into a contemporary multi-level surgical approach will offer much greater success.
In an effort to control the condition, many people spend long nights hooked up to a mechanical breathing device (a CPAP machine) or wear bulky dental plates – known as a Mandibular Advancement Splint (MAS) - to move the lower jaw forward.
Unfortunately, for up to 50 per cent of the estimated one million Australians who suffer from the condition, they cannot tolerate CPAP therapy which forces air into their lungs, while MAS therapy is limited by cost, tolerance and sometimes clinical effectiveness.
“Sleep apnoea is placing a big burden on the nation’s public health system,” Assoc Prof Antic said.
“The problem we have is there are so many patients with the disease and the main treatment is CPAP…but it’s only tolerated by about 50 to 70 per cent of patients so there is this big number of people who can’t use it and need other therapies.
“Having surgical techniques to help those patients is critical.”
The new procedure, to be applied to patients in Adelaide and Wollongong, NSW, combines an advanced version of an existing surgery to remove the tonsils and reconstruct the soft palate (uvulopharyngopalatoplasty, UPPP) with a less invasive operation to shrink the tongue (coblation channelling of the tongue, CCT).
In March this year, AISH was awarded a $630,000 National Health and Medical Research Council) project grant to further explore the new technique.
Preliminary data surrounding the new procedure was presented at the American Thoracic Society Meeting in Philadelphia in 2013 where it was agreed that a more detailed study, if resulting in positive outcomes, could change clinical practice around the world.
Dr Ooi said early data suggested the technique, which incorporates the “exciting new technology of being able to remove, or reduce, tongue tissue safely”, could improve the quality of life for many more patients by reducing collapse of the tongue and throat tissues.
People aged between 18 and 70 who have moderate to severe sleep apnoea and have failed to tolerate or benefit from CPAP and MAS could be eligible to take part in the trial.
The study involves physicians and surgeons from RGH, FMC, Flinders Private Hospital, Memorial Hospital, Royal Adelaide Hospital, Wollongong Hospital and Figtree Private Hospital, Illawarra ENT Head and Neck Clinic, and the University of Washington in Seattle.