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[Treatment] MMA on young patient with light apnea (25yo, AHI 11.9)
#1
Hi, I'm writing this post to seek advice on potential surgical treatment of sleep apnea.

Summary: I'm 25, and have light sleep apnea (AHI=11.9). CPAP treatment didn't resolve my daytime sleepiness; and my sleep ENT doctor suggests I receive a MMA. Should I receive MMA?


Full story: I'm 24, and have a BMI of 19.5. After being pointed out that I was gasping during my sleep, I consulted a sleep specialist. I used CPAP for a year for virtually all occasions that I slept; and a sleep study showed that my AHI decreased to virtually zero (0.4) with CPAP.

However, after using the machine for a year, I was not able to feel the benefit of the machine; in fact, when I visited my sleep clinic a year later and took the Epworth test again, my score had increased.

I was referred to a sleep ENT specialist, who conducted sleep endoscopy for me. He found that I most likely have a deviated septum (nose); and that both my soft palette and tongue base inhibit my airway during my sleep.

He then laid out the surgical treatment options that exist; including a description of the conventional "phase one" treatment; but pointed out its lower success rate and likeliness of my having to receive more treatment in the near future.

An other option that he described was MMA. If I remember correctly, he suggested that my bone structure was a candidate for surgical success; and that a drastic surgery would make sense given that I was young, and my sleep endoscopy showed that my nose, soft palatte and tougue were all possibly was contributing to my apnea.

Hence, I have two sets of questions that I'm interested in understanding more, and am seeking advice:

(1) Given my light apnea, is MMA an adequate surgical option? Conventional wisdom (academic papers) seem to suggest that MMA is typically conducted on relatively older patient with more severe AHI. Does anyone have any knowledge of MMA on younger (20-30s) people?

(2) Given my light apnea, I'm not sufficiently convinced that any sleep apnea surgery would help moderate my daytime sleepiness. Is there anything I can do to be sure that sleep apnea is the primary reason for my sleepiness?

Thank you for any comments and support in advance.
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#2
I can only speak for myself but I would never have surgery except as a last resort I would however look and see if there's other reasons that you were still sleeping during the day maybe you have maybe you have narcolepsy maybe you have restless leg syndrome and personally I would see a neurologist first and rule out other issues before I would even think of surgery but that's just my opinion
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#3
Hi nemui,
WELCOME! to the forum.!
A lot of times when people get the surgery, they still wind up having to use CPAP anyway, of course, YMMV,but hang in there for more answers to your questions.
Much success to you.
trish6hundred
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#4
one thing I do notice a lot here as I have lurked and listened - some people knock out their apneas, but still do not get restful sleep. it is disheartening. There must be something else going on in addition to the actual apnea and hypopnea. other things might be disrupting sleep, or preventing sleep. a neurologist should be able to help, and I would think it might be something EEG brainwave study or treatment would be included.

before you go much further, have someone here or at the doctor help you see your actual sleep patterns. much can be deduced from it.

There is no reason you should resist getting the free ResScan or SleepyHead software.

excessive daytime sleepiness is deadly.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#5
I'm not a doctor nor do I play one on the internet.

My thoughts are that these surgeries do not work very well on the vast majority of people. The ones they work on are few and far between. Even those that have it done are never really "cured". It is a treatment that kinda puts the sleep apnea into remission, I guess. So as young as you are, yeah, not a good idea.

Have they done one of the daytime tests on you? A sleep latency test I think is what it is called.

I'm glad, though, that you are using a CPAP. Keep using it. Which S9 do you have? If you do not have the Autoset, try to get one. With your situation, it would be the best machine for you. Or the Phillips Respironics version which is the 660 I believe. You can use the machine as a kind of limited sleep lab each night to determine the best pressure for you. You can even view the data yourself, watch the data for trends, and adjust the pressures every other week or so until it is the optimum for you.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#6
Hi nemui. If I understood you correctly, your AHI when on CPAP is virtually zero. In this case the pressure from the machine is already preventing your tongue and palate from obstructing your airway. I wouldn't expect the surgery to do any better. As Quiescence said, there is probably something else at play which is causing your sleepiness. In your place I wouldn't consider the surgery except as a last resort when everything else had been excluded.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
Even though you are young, I would see a cardiologist before opting for surgery.
Perhaps you have a congenital heart defect. In about 25% of the population, the foramen ovale fails to close at birth.
Something to rule out...

And, if CPAP brings decent results, I would never opt for such surgery.
(As my high school machine shop teacher, Mr Lee Baxter said, "You can take off metal very easily, putting it back is hard.")
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
Thank you all for your responses. They have been very helpful, as I will be meeting my sleep surgery doctor soon, and wanted to learn more about what other treatment options exist/what other diseases might be to blame/what other tests I can do.

Some other tests that seem to be mentioned so far are: test that I should consult a neurologist about (brainwave study?); having my tyroid checked; and tests that I should consult a cardiologist about.

I’ll try to clarify some points. In addition to OSA, there was periodic limb movement during initial sleep study (PLM index 33.1). It is unfortunate that I slept on my back for most of the night during my sleep study; I make some effort to sleep on my side ever since I found out about OSA.

I use the Resmed S9 AutoSet with humidifier and nose mask; with the pressure range set at 10-12. According to the average of the past year form ResScan, median pressure is 10.8; 95th percentile is 11.9.

Data from ResScan suggests that I sleep 6-7 hours per night (6:28 median; 6:18 average); AHI of 0.5; Apnea index 0.2; central 0.1; obstructive 0.0; hypopnea index 0.2. There is some leaking (median 0.0; 95th percentile 24.0); but I’m rarely waken up by the leaking; and my S9 shows a smiley face each morning, so I’ve assumed that this is not an issue.

I believe using CPAP makes me feel just marginally better; although from time to time I experience light bloating which I address with Simethicone in the morning. (I’ve also tried a full face mask, but it was unbearable.)

The reason why I sought alternatives to CPAP was not necessarily because CPAP was unbearable, but because I didn’t feel all that much better with CPAP (for example, I’m more likely to have light headaches without CPAP; but it’s a common occurrence even when using CPAP as well.); at the time I reasoned that it was because having a mask on my face etc. was making my sleep lighter.

If it helps, my hands and feet are not usually cold.
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#9
something else that I forgot to say is that depending on how long you had untreated apnea it could take a while for your body to recover from what it went through. some people have heart issues and other organ is she could be a possibility at any rate untreated apnea can wreak havoc on our body and just like if you get pneumonia it takes a while to recover and sometimes it takes more than a year depending on the medical issues that came about from being untreated hope this makes sense to you
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#10
if you are only feeling marginally better, there may be sleep stages that you are not experiencing routinely.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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