Apnea Surgical

Apnea Surgical


Patient Selection and Efficacy of Pillar Implant Technique for Treatment of Snoring and Obstructive Sleep Apnea/Hypopnea Syndrome

Friedman MVidyasagar RBliznikas DJoseph NJ.

Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian St. Luke's Medical Center, Chicago, IL; Division of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago, IL.

OBJECTIVE: Pillar implant (PIT) is a simple, office-based procedure with minimal morbidity that was introduced in 2003 to treat snoring and mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). We studied the: (1) success rate using subjective symptoms and objective polysomnographic improvement; (2) success rate based on BMI, OSAHS severity and Friedman tongue position (FTP); and (3) its value as an adjunctive or revision procedure. 

STUDY DESIGN AND SETTING: Retrospective review of 125 patients who underwent the PIT for snoring and OSAHS. Patients were grouped: Group I had PIT only (n = 29); Group II received adjunctive nasal procedures (n = 37), Group III received adjunctive oropharyngeal procedures (n = 55); and Group IV had failed previous UPPP (n = 4). 

RESULTS: Overall subjective and objective "cure" rates were 88.0% and 34.4%, respectively. Group IIb had the best objective cure rate of 46.7%. Neither AHI nor BMI correlated with outcome measures, whereas FTP did correlate. (FTP I and II had improved success vs FTP III and IV). Ten patients had partial extrusion of the PIT. These were removed and new PIT were carried out at a later date. 

CONCLUSIONS: Based on a short-term study, the Pillar implant is an effective treatment for snoring and OSAHS in selected patients and can be combined with adjunctive procedures to treat OSAHS. EBM rating: B-3b.PMID: 16455363 [PubMed - as supplied by publisher]


For the 18 million people living with sleep apnea , under 50% regularly use their CPAP mask while sleeping at night. Common patient complaints are that the masks, which opens the upper airway with pressurized air through a tube, are uncomfortable, awkward, and claustrophobic. Rates of sleep apnea are rising in the US and many people go undiagnosed. The real number of people with the disorder may even be as high as 30 million. In response to growing numbers, CPAP manufacturers (Philips Respironics, a Pittsburgh unit of Philips Electronics NV, and ResMed Inc., of San Diego) are making changes to the masks that will hopefully make them more comfortable. Design changes include softer materials, air pumps that are smaller and quieter, built-in humidifiers that keep air moist, and full face masks for bearded individuals.

Other treatments for sleep apnea include dental appliances that create more air space by drawing the jaw forward and surgery, which is normally reserved for more extreme cases. According to a feature on the challenges of CPAP use in the Wall Street Journal , 60-70% of sleep apnea patients opt for treatment by CPAP mask, which costs between $500 and $4000 but is typically covered by insurance.

The National Sleep Foundation has the following recommendations for those who would like to improve their quality of sleep with a CPAP mask:

    • Attend a CPAP titration sleep study in which you will have the opportunity to try on CPAP masks of different shapes and sizes and decide which one is most comfortable.
  • Contact your sleep specialist if you are still having trouble breathing with the CPAP so that adjustments can be made.
    • Put on the CPAP when the lights are shut off and put back on when it is knocked off in the middle of the night. To be effective, the CPAP should be worn for 6-8 hours each night.

    Learn more about sleep apnea, CPAP care and check out the Wall Street Journal feature on new efforts to treat sleep apnea, " The New Face of Sleep ".

    Diaphragm strength and sleep.
    If you're like most people, you know that one of the biggest dangers of snoring and untreated sleep apnea is a reduction in the body's intake of oxygen. It's a little known fact that your diaphragm muscles can be a HUGE help in reducing sleep apnea and breathing volume. 
    The diaphragm muscles are responsible for breathing – weak muscles mean your breathing isn't as strong or as easily deepened as it should be.  But there is hope!
    There are a few key breathing development techniques and exercises that are meant to strengthen the diaphragm and increase lung volume and oxygen intake.  
    Without the right amount of oxygen, we experience fatigue and depression, and low oxygen levels can also lead to serious health conditions such as heart failure.  By following our program in our Sleep program you'll be well on your way to a stronger diaphragm, greater lung volume and more oxygen. 

    From Mike:

    For extreme emergency cases this may be a viable short term solution until the person has fully developed their breathing. begin here. I guarantee improvement

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