Sleep Apnea and Scarring

In the medical world, the word scarring has negative implications. Other similar words include growth, tumor, and lump, all of which are words used to describe certain anatomic features without any prognostic value. Whenever a doctor uses words "scar tissue," it evokes an image of a complication or adverse effect. However, with sleep apnea and snoring procedures, scarring is usually a good thing. 

Many of the procedures that are performed in the upper airway rely on fibrosis and scarring, not only to shrink the soft tissues, but also to tighten floppy structures and prevent either vibrations or obstruction. For example, many of the various soft palatal snoring procedures are dependent on significant scarring for good results. Whether it's using one of the minimally invasive procedures without any cutting (injection snoreplasty, radiofreqeuncy stiffening, or the Pillar implants), or the ones that involve cutting or tissue vaporizing (laser procedures and the UPPP), the appropriate level of scarring in the right place will determine whether or not the procedure is successful. Of course, sometimes, you'll have scarring in the wrong places, which can be complication.

 

In the nose, many of the turbinate procedures involve irritating, burning, or destroying the blood vessels and soft tissues underneath the mucous membranes. With time, scarring occurs inside the turbinates, with tightening and shrinkage, leading to better nasal breathing.

 

The challenge with many of the more "minimally invasive" snoring and sleep apnea procedures is that you'll tend to get minimal results. Most will work very well initially, but in my experience, there's a significant degree of recurrence years later. One of the main reasons for this is that these minimally invasive procedures usually only address one area. Obstructive sleep apnea, by definition, means that you have some degree of narrowing in multiple levels of your entire upper airway, from the tip of your nose to your voice box. Stiffening your soft palate when you have nasal congestion or tongue base collapse is not going to treat the problem definitively. In carefully selected patients, these minimal procedures can be useful, but many will need more aggressive, multi-level procedures later on.

 

Did you undergo one of the soft palatal stiffening procedures? Did it work for you? Please describe your experiences below in the comments box.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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One thought on “Sleep Apnea and Scarring

  1. I had sleep apnea while in service and I had a PPP/tonsillectomy. Three months later I had recurring snoring and waking up gasping for air, so I requested a sleep study to see if the surgery failed ad my Navy ENT assured me 100% results. Before the surgery my AHI was 29.83 and my supine AHI was 59,4. When I finally got the new sleep study 5 months post op. My AHI was 4 and my supine AHI was 10.5. My diagnosis was primary snoring and was told to sleep on my side. Easier said than done. Five months after the miraculous cured, I was falling asleep everywhere I sat at, I was tired as heck and I gained 10 pounds (BMI pre-surgery and post surgery was 28.56) and went up to 29.86). I requested another sleep study but the Navy denied me the study. Telling me to lose weight and to continue to sleep on my side rather than looking further into another differential diagnosis since my body fat was at 20% when the issues recurred, my neck had grown from exercising to stay in shape from 14 to 17.5 inches, I suffered from severe reflux, depression and anxiety. I have been fighting this since 2007 and I just got denied again because eventhough all the research shows that PPP/Tonsellectomies have a high failure rate and that those surgeries are now being offered after CPAP failure for symptom reduction not curative results the VA wont accept it unless a doctor writes me a nexus letter specific to me. I am glad that doctors like you are educating us, I just wish that the Veterans Affairs Benefits Section would allow us to show them research and opinions like yours rather than being shut down because citing research is not enough coming from a lay person like me.