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Sleep & Snoring

 

 

Handouts

Sleep Questionaire for Adults
Pediatric Sleep Airway Assessment for Children
Sleep Apnea Palate Procedure
How to Talk to Your Bed Partner About Snoring

Snoring

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. Snoring is an indication of obstructed breathing. Therefore, it should not be taken lightly. An otolaryngologist can help you to determine where the encumbrance may be and offer solutions for this noisy and often embarrassing behavior.

What causes snoring?

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway (see illustration) where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist, as a tonsillectomy and adenoidectomy may be required to return the child to full health.

People who snore may suffer from:

  • Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep.

  • Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or tumors can also cause bulk, but they are rare.

  • Long soft palate and/or uvula. A long palate narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters even worse.

  • Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection.

Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

Why is snoring serious?

Socially – It can make the snorer an object of ridicule and causes others sleepless nights and resentfulness.

Medically – It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.

What is obstructive sleep apnea?

When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.

The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.


Is there a cure for heavy snoring?

Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer’s health.

What treatments are available?

Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids.

Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist—head and neck surgeons:

  • Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages.

  • Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radiofrequency. Laser Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to shrink the uvula and tighten a specified portion of the palate in a series of small procedures in a doctor’s office under local anesthesia. Radiofrequency ablation—some with temperature control approved by the FDA—utilizes a needle electrode to emit energy to shrink excess tissue in the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction).

  • Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.

If surgery is too risky or unwanted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or “CPAP”.

Do you recommend the use of over-the-counter devices?

More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Some are variations on the old idea of sewing a sock that holds a tennis ball on the pajama back to force the snorer to sleep on his side since snoring is often worse when a person sleeps on his back. Some devices reposition the lower jaw forward; some open nasal air passages; a few others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. But, if you snore, the truth is that it is not under your control. If anti-snoring devices work, it is probably because they keep you awake.

Self-help for the light snorer

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

  • Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
  • Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
  • Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
  • Establish regular sleeping patterns
  • Sleep on your side rather than your back.
  • Tilt the head of your bed upwards four inches

What is Sleep Apnea?

Sleep apnea is a common disorder that can be serious. In sleep apnea, your breathing stops or gets very shallow. Each pause in breathing typically lasts 10 to 20 seconds or more. These pauses can occur 20 to 30 times or more an hour.

The most common type is obstructive sleep apnea. That means you are unable to get enough air through your mouth and nose into your lungs. When that happens, the amount of oxygen in your blood may drop. Normal breaths resume with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea.

When your sleep is interrupted throughout the night, you can be drowsy during the day. People with sleep apnea are at higher risk for car crashes, work-related accidents and other medical problems. If you have it, it is important to get treatment.

Signs of Obstructive Sleep Apnea

  • Loud snoring followed by a breathless pause.
  • A snort or gasp following the breathless pause.
  • Restless movements while asleep.
  • Frequent awakenings.
  • Morning headaches.
  • Problems with memory and concentration.
  • Extreme tiredness or sleepiness (frequent interruption of sleep).
  • Irritability and a short temper.
  • High blood pressure.
  • Impotence.

Workup

  • Thyroid blood test to rule out an underactive thyroid problem.
  • Thorough nose and throat examination with a flexible endoscope by an ear nose & throat specialist.
  • Sleep study at a sleep center.
  • Sleep endoscopy (optional)

Risks of Untraeted OSA

  • High blood pressure.
  • Irregular heartbeat.
  • Heart disease.
  • Stroke.
  • Accidents from excessive daytime sleepiness.
  • Lost productivity.
  • Poor quality of life.

Medical & Surgical Treatment Options

  • Treat nasal allergy and inflammation
  • Treat nasal or sinus infection
  • Nasal septal deviation correction (Septoplasty)
  • Turbinate reduction
  • Adenoidectomy
  • Continuous positive airway pressure (CPAP) mask
  • Tonsillectomy
  • Laser assisted uvulopalatoplasy (LAUP)
  • Soft palate radiofrequency (RF) volume reduction (Somnoplasty or Coblation)
  • Soft palate stiffening with Restore Pillar Implant
  • Uvulopharyngopalatoplasty (UPPP)
  • Repose Genioglossal Advancement (GA)
  • Repose Hyoid Advancement/Myotomy (HM)
  • Genioglossal advancement with osteotomy
  • Thyrohyopexy
  • Upper and lower jaw advancement
  • Tracheostomy

Self Treatment Options

  • Weight loss.
  • Muscle toning and regular exercise.
  • Avoid smoking.
  • Avoid tranquilizers, sleeping pills, and sedating antihistamines.
  • Avoid alcoholic beverages within 4 hours of bedtime.
  • Avoid heavy meals within 5 hours of bedtime.
  • Raise the head of the bed.
  • Sleep on your side, rather than your back.
  • Sew a pocket on your pajama back to hold a tennis ball to prevent rolling over.
  • Try Breathe Right® nasal strips.
  • Dental appliance to move jaws and tongues forward.

Sleep Hygiene

  • Weight loss since excessive weight causes neck and throat tissues to be bulky and flaccid. (See below)
  • Muscle toning and regular exercise. (See below)
  • Avoid smoking.
  • Avoid medications such as tranquilizers, sleeping pills, and antihistamines that cause sedation.
  • Avoid alcoholic beverages within three hours of bedtime.
  • Avoid heavy meals within 5 hours of going to bed.
  • Raise the head of the bed to decrease nose swelling.
  • Sleep on your side, rather than your back.
  • Consider sewing a pocket on your pajama back to hold a tennis ball to prevent rolling over.
  • Keep the room temperature at a comfortable level and avoid excessive warmth.
  • Avoid excessive noise.
  • Establish a regular arousal time in the morning and adhere to it daily, including weekends and vacations, to strengthen circadian cycling.
  • Sleep as much as needed to feel alert during the day, but not more since excessive time in bed seems to fragment sleep.
  • Allow the non-snorer to get to sleep first.

DIET AND EXERCISE TIPS

Excessive body weight contributes to snoring and obstructive sleep apnea, in addition to being a major influence on general health and well-being. Obstructive sleep apnea occurs in about 50-60% of those who are obese. A recent report from the National Center for Health Statistics concludes that seven of 10 adults don’t regularly exercise, and nearly four in 10 aren’t physically active. Lack of exercise can increase the risk of diabetes, heart disease, and stroke. About 300,000 people in the U.S. die each year from diseases related to inactivity. Proper diet and exercise are the mainstays for a healthy lifestyle, although many Americans turn to costly fad diets and exercise programs that fail to provide weight loss and a healthy lifestyle. The basic tenets to gradual weight loss and good health include developing healthy eating habits and increasing daily physical activity.

Self-help guidelines for healthy activity:

  • Consult a physician – men over age 40; women over 50; people with (or at risk for) chronic health problems such as heart disease, diabetes, or obesity.
  • Start out slowly and build up activity gradually over a period of months. This will help avoid soreness and injury.
  • Try to accumulate 30 minutes or more of moderate-intensity cardiovascular activity each day. You can do all 30 minutes together or through short bouts of intermittent activity (e.g. 10 minutes at a time).
  • Add strength-developing exercises at least twice per week.
    Incorporate physical activity into your day (walk to the office or store, take the stairs instead of the elevator, walk or jog at lunch time, etc.).
  • Make leisure time active – garden, walk, ride a bike with family and friends, participate in an exercise class, join in a sports activity.
  • Select activities you enjoy, find satisfying, and give you a feeling of accomplishment. Success leads to increased motivation to be physically active.
  • Be sure your activities are compatible with your age and physical condition.
  • Make it convenient to be active. Choose activities that are readily accessible (right outside your door) like gardening, walking, or jogging.
  • Try “active commuting.” Cycle, walk or in-line skate to work or to the store.

Make your activity enjoyable – listen to music, include family and friends, etc.
For those who are already regularly moderately active, increase the duration and intensity for additional benefits.

Weight loss tips:

  • Take in fewer calories than you expend. Few people understand this basic, simple concept.
  • Eat smaller meals 3-5 times per day.
  • Eat nutrient dense foods such as whole grains, lean proteins, fruits, and vegetables.
  • Eat slowly, and wait 10-15 minutes before taking second helpings.
  • Don’t eliminate everything you like from your diet. Eat those things in small amounts (pizza, candy, cookies, etc.)
  • Prepare healthy snacks that are easily available (cut carrots, apples, etc.)
  • Avoid buffets.
  • Drink plenty of water, especially immediately prior to meals.

The healthy weight approach to dieting:

  • Enjoy a variety of foods that will provide essential nutrients.

  • Three-quarters of your lunch and dinner should be vegetables, fruits, cereals, breads, and other grain products. Snack on fruits and vegetables. Eat lots of dark green and orange vegetables. Choose whole-grain and enriched products more often.

  • Choose lower fat dairy products, leaner meats and alternatives, and foods prepared with little or no fat. Shop for low fat (2% or less) or fat-free products such as milk, yogurt, and cottage cheese. Eat smaller portions of leaner meats, poultry, and fish; remove visible fat from meat and the skin from poultry. Limit the use of extra fat like butter, margarine, and oil. Choose more peas, beans, and lentils

  • Limit salt, caffeine, and alcohol. Minimize the consumption of salt. Cut down on added sugar such as jams, etc. Limit beverages with a high caffeine content (tea, sodas, chocolate drinks) and caffeinated coffee to two cups per day. Minimize alcohol to 1-2 drinks per day.

  • Limit consumption of snack foods such as cookies, donuts, pies, cakes, potato chips, etc. They are high in salt, sugar, fat, and calories, and low in nutritional value.

  • Eat in moderation. If you are not hungry, don’t eat.

Other Unrelated Sleep Problems

Restless Legs Syndrome
People with this disorder have "crawling" sensations in their sleep. The sensation goes away as soon as they get up to "walk it off". Good sleep hygiene, exercise, and avoiding caffeine and other stimulants may help.

Periodic Limb Movement Disorder
Some people's legs or arms jerk repeatedly during sleep. In the morning, they awake feeling tired. This disorder can be diagnosed in the sleep center. Medications (Sinemet, etc.) may help in some cases.

Insomnia
Trouble falling or staying asleep which disrupts your daily life. There are many causes that require specific treatment, but good sleep hygiene often helps.

Narcolepsy
Falling asleep unexpectedly many times a day. This can be embarrassing and dangerous. Good sleep hygiene, medications, and scheduled naps are beneficial.

Frequently Asked Questions

Will my insurance provider pay for the Repose procedures?

Yes, nearly all insurance providers will pay for the Repose procedures, provided you have undergone a sleep study (Polysomnography) and at least tried CPAP long enough to prove that you will not or cannot tolerate the device.

Q: What can I expect immediately after surgery?

Most people experience approximately 5-7 days of difficulty swallowing and/or talking after the Repose Genioglossus Advancement procedure, along with mild to moderate pain. The Repose Hyoid Myotomy procedure has no reported postoperative difficulties, except for the pain associated with the neck incision.

Do most people get the Repose procedures at the same time as palate surgery?

Yes, most Repose surgeries performed in the United States are performed in conjunction with other procedures such as UPPP, pillars or nasal surgery, due to the fact that the majority of sleep apneics suffer from multi-point, multi-level obstruction (i.e. tongue, lower airway, palate and nose). On the other hand, a significant number of surgeons opt to stage surgery to limit the number of procedures you undergo at one sitting, based on their individual assessment of your primary point(s) of obstruction. In other words, your surgeon may perform a UPPP as your initial surgery. After a follow-up sleep study, if you still suffer from sleep apnea, your surgeon will then schedule you for a second surgery designed to address your tongue based or upper airway obstruction.

I have been diagnosed with both hypertension and sleep apnea. Are they related in any way?

Yes, hypertension is frequently the result of sleep apnea. Depression, daytime sleepiness and sometimes congestive heart failure may all be associated with OSA. In children, sleep apnea has been found to lead to or be the cause of Attention Deficit Disorder.

The doctor who conducted my sleep study told me surgery does not work. Is this true?

While there is little dispute that CPAP is approximately 95% effective in curing OSA, patient compliance clocks in at a dismal 40-45%. In short, there has been some historic misunderstandings from both the sleep lab physician and the practicing sleep surgeon. Now, with the advent of quick, minimally invasive surgeries such as the Repose procedures, surgeons can now achieve cures rates in the range of 75-90% when performed in conjunction with palate and nasal surgery. In light of the low compliance numbers associated with CPAP use, Repose surgery in conjunction with palate surgery may very well achieve results far greater than that of mechanical, external CPAP.

Sleep Apnea Surgery

Uvulopalatopharyngoplasty (UPPP) - Adult Tonsillectomy or Sleep Apnea Surgery

The tonsils play an important role as a defense system against infections in the upper respiratory tract during childhood. The tonsils are lymphoid tissues located in the back and on each side of the throat. The adenoid tonsil is also made up of lymphoid tissue and is located in the upper back part of the throat behind the nose. They work together to “catch” and trap incoming infections. Unfortunately, the tonsil and adenoid may become the source of infection itself like a plugged filter or block the upper airway.

Tonsillectomy is recommended for adults with signs and symptoms of:

  • Tonsil (and/or adenoid) enlargement or hypertrophy
  • Upper airway obstruction (snoring, nasal congestion, chronic mouth breathing, restless sleeping, daytime tiredness or sleep apnea)
  • Recurrent throat infections requiring antibiotics (not necessarily strept throat)
  • Tonsillar stones (tonsilliths) causing bad breath, ear pain, foreign throat sensation, lymph node swelling, etc
  • Dental abnormalities from chronic mouth breathing (crossbite, open bite, high arched palate, facial growth disturbances)
  • Peritonsillar abscess
  • Possible malignancy

Numerous medical studies have definitively proven that removal of the tonsils is helpful for the above problems without resulting in any long-term negative impact on the immune system. Fortunately, there is ample other lymphoid tissue still remaining in the throat to perform its immune function (i.e., lingual tonsils on the back of the tongue, accessory tonsils on the back wall of the throat, Gerlach tonsils near the Eustachian tube opening, etc).

Sleep apnea surgery may be performed simultaneously. Surgery most commonly involves shortening the soft palate and uvula at the same time as tonsillectomy. This procedure tightens the loose tissue in the throat to relieve the obstruction of the upper throat. This is called uvulopharyngopalatoplasty or more simply UPPP.

If your obstruction includes the lower throat, your doctor may also perform a procedure called geniohyoid advancement (GHA) with thyrohyopexy (THP). The purpose of this procedure is to pull the back of the tongue forward to increase the size of the lower throat. This procedure requires additional incisions on the inside of the mouth behind the lower lip and also in the front of the upper neck.

RISKS OF SURGERY

The throat heals so well after surgery because of its excellent blood supply. Unfortunately, this is the major reason that the most common major complication after tonsil and adenoid removal is hemorrhage, or excessive bleeding. This occurs in 4% of patients and most commonly occurs six to twelve days following surgery. It is extremely important to notify your doctor before surgery if you or anyone in your family has a tendency to bleed or hemophilia. This includes frequent nosebleeds, easy bruising, excessive bleeding with previous tonsil, dental or other surgery, abnormally heavy menstrual periods, prolonged bleeding after cuts or scrapes, and previous blood transfusions.

The following complications have been known to rarely occur:

  • hemorrhage
  • dehydration requiring hospitalization
  • infection of the ear or throat
  • lip or tooth injury
  • anesthesia problems
  • airway swelling
  • excessive throat scarring
  • permanent speech problems (nasal speech)
  • death

Download (UPPP) Pre and Post Operative Surgery Instructions

Repose® Procedures for Sleep Apnea

Repose® Genioglossus Advancement and Hyoid Suspension

The procedure involves the use of a small titanium screw with attached sutures, which is implanted into the posterior aspect of the lower mandible, at the level of the Genio Tubercle.  A proprietary suture passer is used to internalize a heavy loop of suture through the base of tongue.  Once triangulated, a specific technique is employed to suspend or hammock the base of tongue.  The objective of the Repose GA procedure is to stabilize the base of tongue, not anterior advancement associated with conventional muskuloskeletal advancement.  The procedure minimizes the potential for prolapse and obstruction of the base of tongue when the patient is supine and asleep. 

Over time, a fibrotic bridge forms around the implanted suture, further strengthening the long-term support of the suspension hammock.  For instance, one recent study of 55 patients who underwent Repose GA with UPPP revealed a 78% cure rate at 3 years post procedure (average preoperative AHI = 52.8, average 3 year postoperative AHI = 14.1).  A second peer-reviewed study by Stanford University researchers revealed a higher cure rate for Repose GA versus conventional muskuloskeletal GA. 

Repose® Tongue and Hyoid Suspension

After making a small incision under your chin, your surgeon will use a specially designed inserter to place a small titanium screw into the back side of your lower jaw. Attached to the back end of the screw are two heavy, permanent sutures, which have been fused onto the back end of the screw. Your surgeon will then internalize these sutures inside your tongue.  Following a specific protocol, your surgeon will then suspend or hammock the base of your tongue before closing the small incision under your chin.  You won't feel this suture when you're awake, but when you fall asleep at night, the suture will stop your tongue from collapsing backwards towards the back of your throat, thereby preventing obstruction and apneic episodes.

Two Points of Correction In One Surgery

Hyoid Myotomy is not a stand alone procedure. It must be performed in conjunction with the Repose Genioglossus Advancement. Your surgeon will make a small incision on your neck (if performing both Repose Tongue Advancement and Hyoid Myotomy together, both procedures may be performed through the same incision).  Using the same specially designed inserter, your surgeon will implant two screws into the back side of your jaw, placed in such a manner that you will never feel them once your surgery is complete.  Attached to the back of each screw are two heavy, permanent sutures, which are then passed around your hyoid bone.

Interestingly enough, the hyoid bone is the only bone in the human body not attached to another bone.  It is, however, attached to a number of muscle groups in your neck, which makes it an ideal bone for reconfiguring the human airway.  Once the permanently placed screw sutures have been passed around the hyoid bone, your surgeon can advance the hyoid and associated muscles toward your chin.  The result both opens your upper airway while advancing the base of your tongue.  One quick operation equals a compelling correction for two major points of obstruction.

Coblation® Procedures for Snoring and Sleep Apnea

Coblation® Soft Palate Treatment

Coblation® Soft Palate Treatment can reduce the incidence of snoring without the discomfort and inconvenience associated with traditional surgery. Coblation Soft Palate Treatment is performed with the ReFlex Ultra® 55 Wand and can be performed in an outpatient setting under local anesthesia. The procedure typically takes less than fifteen minutes and the patient will experience a reduction in snoring within six weeks.

In addition, studies published in peer-reviewed journals have shown Coblation Soft Palate Treatment to have numerous clinical advantages:

  • Significant improvement in Eppworth Sleepiness Scales at both the 3 and 9.5 month postoperative visits

  • Significant reduction in snoring reported by both patient and bed partner at 3 and 9.5 month postoperative visits

  • Significant change in the distance between the tip of the uvula and the bottom of the sella indicating a retraction of the uvula

  • Minimal patient discomfort

  • Immediate volumetric palatal tissue removal

  • Continual symptomatic improvement over time due to tissue shrinkage and stiffening as a result of the submucosal lesion being formed

Pillar Procedure®

Now there's a simple, safe, minimally invasive treatment for snoring and mild to moderate obstructive sleep apnea (OSA). Unlike other painful and invasive surgical procedures, the Pillar Procedure is a simple treatment that your doctor can perform in a single short office visit or in combination with other procedures. More than 30,000 people worldwide have been treated with the Pillar Procedure.

During the Pillar Procedure, three tiny polyester implants are placed into the soft palate. Over time, the implants, together with the body's natural fibrotic response, add structural support to and stiffen the soft palate. This structural support and stiffening reduce the tissue vibration that can cause snoring and the palatal tissue collapse that can obstruct the upper airway and cause obstructive sleep apnea (OSA).

Clinical studies of the Pillar Procedure have shown that:

  • Patients experienced a significant decrease in snoring intensity.
  • Bed partner satisfaction with the reduction in snoring after the Pillar Procedure has been documented at 80% or higher.
  • Approximately 80% of patients demonstrated a reduction in their AHI, and results were sustained at one year after the Pillar Procedure.
  • Patients experienced less daytime sleepiness and significant improvements in lifestyle after the Pillar Procedure.

How the Pillar Procedure works

This informative 3D animation provides a simple, visual explanation of the causes of palatal OSA and snoring. The video makes it easy to see how the placement of three tiny implants helps correct the palatal vibration and collapse that can cause snoring and obstructive sleep apnea.

The Pillar Procedure targets the most common cause of snoring and obstructive sleep apnea (OSA)—the soft palate.1,2 During the Pillar Procedure, three tiny woven implants are placed in the soft palate. Over time the implants, together with the body's natural fibrotic response, add structural support to and stiffen the soft palate. This structural support and stiffening reduce the tissue vibration that can cause snoring and the palatal tissue collapse that can obstruct the upper airway and cause obstructive sleep apnea (OSA).

Pillar implants are made of a material that has been used in implantable medical devices for more than 50 years. Patients cannot see or feel the Pillar implants, nor do they interfere with swallowing or speech. Many patients resume normal diet and activities the same day of the procedure.


Pillar Procedure Animation

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