News

New Robotic Surgery Helps Sleep Apnea Sufferers Get Their Z's

January 24, 2012

 

new-robotic-surgery-for-sleep-apnea

Using a new technique made possible by robotic technology, surgeon Jeffrey Ahn is helping some sleep apnea sufferers ditch the CPAP machine and catch some Z's.

After 8 years of struggling with her CPAP machine, Judith Oderwald decided it was time to find another solution to her obstructive sleep apnea.

“I had enough of the machine. You’re fighting with the hose all the time. I switched to a machine that uses a tube that goes up the nose, but that would slip out. And I was still exhausted,” says Mrs. Oderwald, a 69-year-old retiree from New Hyde Park, Long Island.

It was not surprising to Jeffrey Ahn, MD, director of Sleep Disorder & Robotic Surgery at CUMC, that Judith had trouble tolerating CPAP (continuous positive airway pressure).

“CPAP works as long as patients wear it, but it’s cumbersome and about 50 percent of people who try it eventually quit," he says.

While researching other options on the Internet, Judith read about a new robotic surgical procedure that can now help some patients get a good night’s sleep without the machine. Her family physician referred her to Ahn, assistant professor of clinical otolaryngology-head & neck surgery, and one of the few surgeons in the U.S. certified to perform the procedure.

New Technique Removes Hard-to-Treat Obstruction

There are three common areas of the airway that can become obstructed during sleep: the nose, the palate and the base of the tongue. It is simpler to surgically remove excess tissue from the nose and palate, but difficult to reach down into the throat to remove tissue from the tongue base, Ahn says. “The surgeon cannot see well and human hands are too big.”

The new robotic procedure is tailor-made for patients with an obstruction in their tongue base. “The dexterity and miniature instrumentation of robotic surgery allow me to get to the area without making any external incisions,” says Ahn. “The entire procedure is performed through the patient’s mouth. There’s no need for tracheotomy, no scarring, and the patient can go home the next day.”

obstructions-at-base-of-tongue-can-now-be-surgically-treatedDuring sleep, excess tissue can block the airway at the base of the tongue. The condition disappears in about 80 percent of Jeffrey Ahn's patients after robotic surgery.

When a patient is found to have significant obstructive sleep apnea on sleep study, sleep endoscopy, an endoscopic examination of the patient’s upper airway during sleep, is recommended to accurately pinpoint the area of obstruction. Ahn is among the first to use an endoscope equipped with a tiny video camera to highlight problem areas while a patient sleeps.

Like many people with severe obstructive sleep apnea, Judith had obstructions in all three regions.  Ahn addressed the nose and palate first and then used the robot to remove excess lymphoid tissue in Judith’s tongue base.

The robotic procedure was adapted from a technique pioneered at the University of Pennsylvania to remove cancer from the back of the tongue. Ahn completed a rigorous training program in order to gain certification for the surgery. Presently, he is the only surgeon in New York specializing in the robotic treatment of obstructive sleep apnea.

"My daughter can't believe the change it's made"

Two months after the surgery, Judith's throat is still a little sore, but she's now getting a good night's sleep. “Before, it was like I was in a coma all the time. If I sat down, I’d fall asleep. I didn’t have any energy,” she says. “Now I sometimes have to fight to get to sleep. My husband tells me I don’t snore anymore. My daughter can’t believe the change it’s made.”

Ahn cautions patients that their sleep apnea can return if they don’t keep their weight under control, but says most patients lose weight after surgery.

Jeffrey-Ahn-uses-robotic-surgery-to-treat-difficult-cases-of-sleep-apnea

In the two months after her procedure, Judith has lost 30 pounds, which she attributes to her newfound energy. “When you’re tired, I think you go for the wrong foods,” she says. “I’m now out walking the dogs every night, I’m eating better, and the weight’s come off. I don’t intend to go back to bad habits.”

Since obtaining his certification last year, Ahn has now performed 30 robotic surgeries for sleep apnea and the number of patient seeking the treatment is rising rapidly. So far, he is seeing success in approximately 80 percent of patients, and he thinks further minor modification of the epiglottis, at the base of the tongue, could increase the success rate higher.

The success of the robotic technique is similar to that seen with an older surgical technique – maxillomandibular advancement – that pushes the jaw forward to enlarge the airway around the tongue base. But only a few patients opt for that surgery because of its highly invasive nature and long recovery time.

“Sleep apnea that stems from tongue base has troubled me for the 15 years I’ve been doing sleep apnea surgery,” Ahn says. “But I think now we have a technique that is finally capable of helping the majority of our patients.”

For more information contact Jeffrey Ahn, MD, at 212-714-9494.

--Susan Conova

  • Find Columbia Doctors