DEAR DR. ROACH: My son, who is 30 years old, was recently diagnosed with severe obstructive sleep apnea and currently uses a CPAP machine. He says does not want to use this for the rest of his life, therefore, he has researched surgery to correct his OSA. Recently he consulted with a sleep expert, and now has surgery scheduled with that doctor. My son will have a septoplasty and a palate expansion before a more radical surgery in a year called MMA. My son feels that these surgeries will give him the longest lasting cure for his OSA. I am very concerned about all of these surgeries. I value your objective opinion and hope you can give me some reassurance that these surgeries are worth the pain. — G.M.
ANSWER: Although CPAP (continuous positive airway pressure, which works by using air to keep the airway open) is the usual treatment for obstructive sleep apnea, surgery is another effective way to treat OSA. Surgery is most appropriate for those who wish a surgical solution (some people can’t stand the CPAP machine), those who have a surgically correctable problem (see below), and those who are good candidates for surgery; younger age makes surgery seem more reasonable to me.
The specific surgery chosen depends on an individual’s unique anatomy. Surgery on the uvula (yes, the dangling thing at the back of the throat), soft palate and pharynx is the most common surgery, but maxillomandibular advancement surgery (MMA) has been shown to be successful in several well-known medical centers in the U.S., such as Mayo Clinic and Stanford.
Success rates are high, and some studies have shown surgical cure of obstructive sleep apnea in over half of those who undergo the procedure. Not knowing your son and not being a surgeon, I can’t give an objective opinion for him in particular, but I can say that in appropriate patients, surgical treatment of OSA is reasonable.
DEAR DR. ROACH: Is there any good way to find the correct blood pressure medicine that doesn’t suck the life pep out of you, give you a headache, make you short of breath when walking or grapple with all of those side effects at once? Who should manage that program, your regular doctor or your cardiologist? Is there another specialist with the right insight and expertise? — E.M.
ANSWER: Choosing the best blood pressure medicine for a person with high blood pressure starts with knowing as much as possible about the person’s heart and blood vessels, and their other medical conditions. A person with blockages in the arteries should be on a beta blocker and ACE inhibitor most of the time.
A person with diabetes should be on an ACE inhibitor or angiotensin receptor blocker. An older person with isolated high systolic pressure may get most benefit from a diuretic. However, it may still take some trial and error to find the best choice. Most people are able to find a blood pressure regimen that has very few side effects.
Most generalists have expertise in blood-pressure medications, and are likely to know all your conditions. Cardiologists have more expertise in cardiovascular disease, and I refer to high blood pressure experts when I have difficulty getting someone’s blood pressure under control.