Three tiny polyester cords placed in the floppy tissue near the back of the roof of the mouth have been proven to curb snoring and now researchers want to know if they can stop potentially dangerous sleep apnea as well.
The Medical College of Georgia is one of handful of sites in the nation studying the Pillar Palatal Implant System -- approved by the Food and Drug Administration in December 2002 to treat snoring -- for its potential in sleep apnea, says Dr. David J. Terris, chair of the MCG Department of Otolaryngology-Head and Neck Surgery.
“This is the most recent innovation in treating snoring,” he says. “It’s a one-step procedure where you insert a biologically inert implant made of Dacron … in the palate at three different locations and it works like a batten on a sail. Instead of the palate flopping and fluttering, these battens make it a little stiff so it doesn’t flutter.”
Air moving past this fluttering, floppy tissue just behind the hard palate, makes the annoying snoring sound. Muscles are more taut when you are awake, but during sleep they relax and the noise begins, says Dr. Terris. Anatomy can play a role; a big tongue or tonsils or a small jaw can worsen the problem. “Just like other parts of our bodies tend to sag a little with age, throat tissues tend to sag and that predisposes this to collapse,” he says.
People also tend to gain weight with age. “If you are overweight, you get fatty deposition in your abdomen as well as your neck and throat, so that plays a role.” Alcohol and sedatives increase relaxation and the problem.
The net effect is snoring and, even worse, sleep apnea, if the contributing factors completely obstruct the airway. With sleep apnea, people can’t breathe, wake up briefly and start breathing again often many times over a night. They are habitually tired, often falling asleep at inopportune times such as behind the wheel or at work. “It’s really a bad disease when it’s a severe case,” says Dr. Terris who works as part of a multispecialty sleep team at MCG that includes dentists, sleep specialists and oral surgeons to examine patients with snoring and/or sleep apnea and identify the best treatment. MCG Medical Center is among a few facilities in the state that offers the Pillar system for snoring as one of the choices. “It’s easier to fix snoring than sleep apnea, but if you fix sleep apnea, you probably fix snoring,” said Dr. Terris. He and Dr. Christine G. Gourin, MCG otolaryngologist, are investigators on the trial that will help determine if the Pillar approach does both.
The tubes, inserted into the soft palate in a brief outpatient procedure, make use of the body’s natural desire to heal. The tubes themselves provide some stability to the normally mobile tissue near the back of the throat and the scarring that results from the localized trauma makes it more sturdy and likely slightly smaller.
The mouth heals quickly, so patients may need an over-the-counter pain reliever for a few days. Sleep studies that monitor breathing and snoring are performed before and after the tubes are implanted.
Eligible patients include adults with mild to moderate sleep apnea who have a consistent bed partner -- this person will fill out a diary regarding frequency of snoring, etc. -- and cannot be morbidly obese. MCG will enroll about 30 patients in the study; nationally about 100 people will participate.