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Question 3 - Does pillar implant work?

From: Michael K.

I am 31 years old and have been dealing with severe sleep apnea for the past few years. I first tried CPAP, then BiPAP. The pressure is so high, I get lots of air in my belly and just doesn't’t feel good in the morning. I am still tired even when I use the machine all night. I finally tried a mouth piece. It did help alittle, but my jaw aches in the morning and my bite doesn't feel the same after using it for only 6 months. I have looked at surgery, but am just so turned off by all of the risks with UPPP. I went to see an ENT surgeon last week and was told that Pillar implant is an options for me. It sounds much less drastic than UPPP. Does Pillar implant work?

 


Answer Provided by Dr. Kasey Li
June 17, 2007

Something that sounds too good to be true usually is just that. The saying “there is no free lunch” apply's to sleep apnea treatment as well. The rationale of the Pillar implants is to stiffen the soft palate to reduce the vibration and collapse of the tissues. The implants are made of Polyethylene Terephthalate (essentially Nylon). The same material was used as sheets for hernia repair in the past. Three (some do five now) implants are placed in the soft palate under local anesthesia. There are a few potential complications such as foreign body sensation in the throat, infection, and extrusion of the implants. Last but not least, ineffectiveness of the procedure. Obviously, it is minimally invasive and the implants can be removed if there are issues.

The concept is really the same as the old Somnoplasty of the soft palate (creating scars in the soft palate to stiffen it and LAUP, UPPP…etc. all create scars). The advantages of Pillar implants over Somnoplasty is that it is a single procedure and potentially last longer because scars “softens” with time but the implants don’t. The problem with Pillar implant is that it may help with snoring and probably with just limited improvement of OSA in some cases, at best. I base my assessment by analyzing the literature and the available data. For example, 6-8 months ago, Pillar implants were advocated for moderate OSA.

While looking at 46 treated patients, 36 patients improved with the average AHI drop from 16.6 to 8.0 after implantation. That is a 50% improvement and sounds great! Right? No! When looking at data, you need to look at the entire population. There were five patients with average AHI from 16.5 to 22 and another five patients average from 18.6 to 38.5. If you average out the entire population of 46 patients, there was little change in the AHI. I select my patients for Pillar implants VERY carefully. I think there is a very limited population that are candidates for the procedure (just like Somnoplasty). I limited the procedure to essentially patients with simple snoring and very mild OSA.

Obviously, there would be many surgeons and patients who would disagree with me. Clearly, different surgeons have different experience and results. But my opinion on this treatment is simply based on the available data. Indeed, there are data showing the use of Pillar implants improves OSA, but many of the patients in those studies had nasal surgery, RF to the tongue…etc. So, did the improvement come from the Pillar implants? Or from the RF tongue treatment and nasal surgery?



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