UPPP More Successful Than CPAP

[roster]

One study that I recall showed that even the 40% success rate (of uvulopalatopharyngoplasty) was better in the long term than CPAP. Patients were recruited from a VA hospital with newly diagnosed sleep apnea and two groups were followed: CPAP users and UPPP patients. What why found a few years later was that you had a higher chance of being alive if you underwent a UPPP than if you were assigned to the CPAP group. Even though the overall success rate for UPPP is only 40%, these 40% stayed "successful", at least for the first few years. CPAP users, on the other hand, probably began to drop off in using their CPAP machines, at after a few years, compliance was poor. Based on research that shows that your overall risk of dying from cardiovascular disease in much higher if your have untreated sleep apnea, these results make sense.

See the rest of Dr. Park's article at http://doctorstevenpark.com/uppp-revisi ... leep-apnea

[Cygnusia]

But... if you stay compliant (with the occasional tweaking), it's 100% effective, right? I think I'd rather stick with the 100% shot than an iffy 40%...

[cinco777]

Cygnusia wrote

But... if you stay compliant (with the occasional tweaking), it's 100% effective, right? I think I'd rather stick with the 100% shot than an iffy 40%

YES. For this Study, 100% CPAP Compliance would = 100% Effective Treatment.

[Silver Pelt]

One has to use a lot of caution with studies like these. If the objective is to prolong life, then the only meaningful measure is overall mortality. Many studies of surgical procedures, drugs, etc. report misleading results because they only count deaths that can be directly related to the condition being treated.

But surgery of any kind is very stressful, more so with older folks. These stresses can affect many aspects of health, ranging from immune response to physical activity levels to liver function and so forth. Many surgeries are followed by long-term treatment with powerful drugs, which have detrimental side effects unrelated to the surgery. If you get a coronary bypass (just to pick on something other than UPPP) and die 4 years later of kidney failure, while the ones who avoided surgery did not, you are still dead. If you die of pneumonia 6 months after surgery because pain and other consequences of the surgery prevented good physical exercise, many studies wouldn't count the death in their results. So a study that reports that people getting coronary bypass surgery don't die of heart attacks as often compared to other treatments is meaningless if there is no difference of overall mortality in the two populations.

There are other objectives beyond simply prolonging life. Quality of life is very important but hard to measure, so it doesn't get considered in nearly as much detail in most studies. When your life expectancy is down to 10 or 20 years, spending a year or two recovering from major surgery represents a major loss in remaining quality of life. Every surgery I have had resulted in lasting effects that certainly decreased quality of life. I learn to live with them, but they are still there. If xPAP can provide effective therapy without the risks of surgery, I would be strongly motivated to continue xPAP and avoid surgery. xPAP has its own impact on quality of life; everyone needs to make their choice. The trouble with surgery is that you can't go back, unlike returning to xPAP therapy.

[rested gal]

Studies that speak of being compliant using CPAP often define "compliance" as using a CPAP machine at least 4 hours a night, at least 5 days a week. The absolute minimum most insurance and Medicare require for "compliance."

I will always be very leery of the results from studies that call it "CPAP treatment" when some of the cpap users in the study may have been using their machines so little of their sleep time.

And then there are the leaks that never seem to get looked at.... a lot of the so-called "treatment" is probably gushing out into the bedroom for some of the people who use their machine almost 100% of the time.

Oh well.

The kind of checking I'd want to see done on the people using CPAP before calling them "cpap patients" for purposes of comparison with other treatment methods would make the study too expensive to do.

[Davidwnc]

I wonder which category I would be in? I've been on CPAP therapy for about 15 years or so, but about 8 years ago I had UPPP. Maybe there is an 'All of the above' choice.

To be fair, at the time my Dr. told me it wouold not cure my apnea, just reduce it's severity (the way my pressure had been increasing I had been worried that eventually I would need a jet engine by the side of the bed!!!)

[cinco777]

Silver Pelt wrote

So a study that reports that people getting coronary bypass surgery don't die of heart attacks as often compared to other treatments is meaningless if there is no difference of overall mortality in the two populations.

I have reached the same conclusion as Silver Pelt. I believe that the Difference in Overall Mortality in the two populations is the honest and valid way to assess whether the drug/treatment/surgery has a positive effect or a negative one. Too many studies see the trees and not the forest (overall mortality rate) and report conclusions detrimental to our health and well being.

I discovered this to be true re my taking cholesterol lowering drugs over a 10-year period at ever increasing dosages because new studies kept pushing the acceptable cholesterol level lower and lower. The "trees" studies said that these lower levels of cholesterol were GOOD for me. My (and others) "forest" analyses that looked at overall mortality rates and quality of life showed otherwise. I experimented and made changes to my dosage levels (I took control of my health) and am now content with my new Total cholesterol level of 160 and LDL of 100 (was 105 and 60) as my long term memory returned and my nerve pain left. I shared my findings with my Dr. throughout my 9-month experimentation journey. He didn't always agree but he understood my rationale for lowering my daily dosage and was surprised, but not skeptical, when I informed him that my long term memory was back and my "nerve" pain was gone.

I am not a medical professional. I am only reporting my personal observations and experiences. YMMV.

[roster]

cinco,

I understand what you are saying about cholesterol, however it seems like the words "trees" and "forest" should be switched. But then it is early and I still have some cobwebs.

To carry your analogy a step further, I will say that cpaptalk.com members, who are committed CPAPers in control of their own therapy, are a special little "grove of trees" that get very special results.

[Scarlet834]

This was a very interesting thread, and I agree with rooster--we are a special little subset of the sleep apnea population. I see this as very much the reason we need to be responsible for our own health, as answers reached through combining people who do and do not participate in their own medical treatment might not reach a conclusion that applies to someone who is very knowledge-seeking and involved.

Thank you, cinco, for enriching the discussion with a different medical example.

[raggedykat]

[quoteStudies that speak of being compliant using CPAP often define "compliance" as using a CPAP machine at least 4 hours a night, at least 5 days a week. The absolute minimum most insurance and Medicare require for "compliance."
][/quote]

So if you are using your cpap machine for the 8 or 9 hours you sleep at night and even when you nap and making sure your numbers stay in the acceptable range isn't that helping to prevent cardiovascular disease associated with sleep apnea? Please tell me this is so.

[Hawthorne]

That is definitely so! Yes it is!

[rested gal]

So if you are using your cpap machine for the 8 or 9 hours you sleep at night and even when you nap and making sure your numbers stay in the acceptable range isn't that helping to prevent cardiovascular disease associated with sleep apnea? Please tell me this is so.

Yup. 'tis so.

[raggedykat]

Thank you!

[raggedykat]

I have tried so hard to make this work, I was afraid it was for nothing.

[Pugsy]

I have tried so hard to make this work, I was afraid it was for nothing.

While we yearn for those visible landmarks that define out therapy like more energy, feeling better, resting better, etc.... The behind the scenes preventative measures like reducing cardiovascular related stuff sort of gets neglected. Even if someone "feels" no improvement, if they were reducing their number of events or severity, then prevention is going on behind the scenes and we don't "feel" it. It might prevent us from "feeling" a heart attack or stroke in the future.