Lasers in the management of snoring and mild sleep apnea

Abstract

In a field that is as complex and confusing as the management of sleep apnea, perhaps no greater controversy has existed over the last few years than the use and efficacy of lasers as a mode of treatment. As with many recent advances in high technology (and especially, when no good low-technology treatment exists), initial enthusiasm and hype, usually propagated by apparent clinical success rather than substantial and objective research, is eventually overtaken by the inevitable complications, lack of the initially seen spectacular results, and the reality that technology is not a replacement for good surgical principles and skill. Eventually, and this is certainly true for the use of lasers in the management of snoring and mild sleep apnea, the practical answer falls somewhere in the middle, indicating that the use of this technology is very much indicated in some cases and contraindicated in others. It is the inherent responsibility of the good practitioner, therefore, to have the data and wisdom to be able to make the clinical judgment differentiating these clinical scenarios. As the pendulum swings back toward its inevitable middle ground based on time and good research, it is becoming more and more evident that lasers have a significant role to play in this disease process, but that role still needs to be better defined. It must be stated at the outset that, in general, the use of lasers in this disease does not represent a new or unique modality of treatment. Rather, the laser is primarily used as a tool to perform procedures that either have been done in the past, or could be done in the present, with other modalities such as scalpels, electrosurgical cautery, or radio-frequency devices. The indication for using the laser is the practical, and sometimes theoretical, advantage(s) it represents in any surgical procedure. These include the lack of intraoperative and postoperative bleeding, the ease of access to traditionally difficult areas such as the soft palate and pharynx, the decrease in postoperative pain, and the decrease in scarring. There are currently two commonly performed laser procedures for snoring and mild sleep apnea: laserassisted uvulopalatoplasty (LAUP) and laser-assisted uvulopalatopharyngoplasty (LA-UPPP). Though there is some overlap in their techniques and indications, they are two distinctly different surgeries and will, therefore, be described separately.