New Options Available at UH for Patients Who Snore
September 25, 2019
Snoring Clinic offers office-based procedures for the nose and soft palate
UH Clinical Update | September 2019
For patients who snore but who perhaps don’t meet the diagnostic criteria for obstructive sleep apnea (OSA), UH is offering office-based treatments that can provide some relief. Patients pay the more modest cost out-of-pocket.
“For the most part, health insurance covers therapy for OSA,” says UH otolaryngologist and sleep specialist Amy Schell, MD. “That diagnosis requires that you have an apnea-hypopnea index of at least 5, meaning that you have at least five events per hour during which you are pausing in your breathing or having dips in your oxygen. There are plenty of patients who have bothersome snoring but don’t necessarily meet those criteria. It was my goal to put together a clinic where we could pursue office-based procedures that would be more feasible to be covered out-of-pocket.”
One of the procedures employed to treat simple snoring is radiofrequency ablation of the palate.
“It involves a wand that’s curved in the shape of the palate that, after locally numbing that area, you insert into the palatal tissue,” Dr. Schell says. “It delivers energy to both shrink that tissue area and also stiffen it so that it’s less likely to generate the snoring noise.”
The whole procedure takes about 30 minutes, with patient prep taking up most of that time. Multiple sessions can be provided, if necessary.
According to Dr. Schell, results are good and can last up to several years. In fact, she says, short-term results for the technique have been shown in placebo-controlled studies – a relative rarity for a procedural or surgical intervention.
“We think that this procedure can at least provide short-term relief of snoring symptoms, she says. “Four, five or six years down the line, that scar tissue can remodel, and there can be return of symptoms, at which point it would have to be addressed again.”
Medical opinion is mixed on whether there is medical morbidity associated with simple snoring, Dr. Schell says. But what’s not in dispute is how bothersome and disruptive it can be to patients and their bed partners.
“There are significant psychosocial implications that come from loud, disruptive snoring,” she says. “I wanted to be able to offer patients an option to address some of those issues.”
For Dr. Schell, the first steps in evaluating a new patient in the Snoring Clinic are taking a detailed history and likely obtaining a sleep study, if one has not been done already.
“A sleep test can distinguish definitively a simple snorer from someone who has OSA,” she says. “We know that around 60 percent of non-obese snorers will have sleep apnea with at least 10 events per hour. So, testing most of these patients is the first step.”
For patients diagnosed as simple snorers, there are various treatment options available, in addition to the radiofrequency ablation.
“We can use CPAP or oral appliances to help with snoring,” Dr. Schell says. “We can also pay attention to lifestyle changes like losing weight or changing sleep position. That will help many of these patients, partially, if not completely. Medical or surgical therapy for an obstructed nasal airway may also improve symptoms.”
For more information or to refer a patient, please call Dr. Schell’s office at 216-844-5470.
Tags: Sleep Medicine