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Sleep Apnea & Snoring

Dr. Kao is a published author on the treatment of obstructive sleep apnea. With 25 years of experience in the surgical treatment of sleep apnea, he is a pioneer in the Multilevel Treatment of Obstructive Sleep Apnea. In a study of over 500 patients, nearly 300 patients had pre- and post-operative polysomnography (sleep study) available for analysis. A 68% overall success rate was achieved with minimally invasive, mostly outpatient surgery. This is very high in that no patients were excluded for excess body mass index or for severity of disease. 

There are basically 3 levels of the upper airway that can cause obstruction: the nasal passages, the tonsil/palatal level, and the hypopharyngeal or base of tongue level.

Traditional surgery for sleep apnea involves tonsillectomy and uvulopalatopharyngplasty at the palatal level. Dr. Kao is an early proponent for preservation of the uvula. He trims the uvula and suspends it up rather than remove the uvula. This prevents reflux of liquids from the throat back up into the nose when eating. Recently, most authors have changed into the uvula preservation group. Dr. Kao also uses plasma knife ( bipolar electricity) for removal of the tonsil and uvula at a cooler temperature (75 degrees Centigrade) rather than electric cautery which removes tissue at a much higher temperature. Most patients experience less pain after surgery with this technique.

The back of the tongue can flop back and cause obstruction in patients with sleep apnea. Most authors advocate suspension of the tongue with suture to a screw attached to the inside surface of the lower jaw. Others split and advance the jaw with bone plates and screws to lift the tongue forward. Dr. Kao has extensive experience with Somnoplasty of the tongue base. This minimally invasive method uses microwave delivered through a needle in the back of the tongue to heat up the tongue to 85 degrees, creating an area of zonal necrosis, followed by shrinkage and scarring that reduces tongue size and pulls it forward to prevent the tongue from flopping backwards when sleeping. Most patients experience minimal discomfort and are able to eat right after somnoplasty.

The nasal passages and sinuses can also block airflow. Most patients with sleep apnea complain about nasal obstruction, which leads to mouth breathing and snoring. When the mouth is open is a supine sleeping position, the tongue naturally falls back causing obstruction and apnea. When indicated, Dr. Kao advocates minimally invasive sinus surgery for sleep apnea. He developed Navigational Sinus Surgery which combines computer guided sinus surgery with balloon sinuplasty to minimize the extent of sinus surgery for maximum effect.