No longer one-size-fits-all, sleep surgery can take many forms for patients with obstructive sleep apnea, says new UH surgeon
UH Clinical Update - September 2018
Treatments for the growing problem of obstructive sleep apnea (OSA) have evolved rapidly in recent years, perhaps most notably with the advent of surgically implanted hypoglossal nerve stimulation in 2014 (Inspire therapy and others). Many patients who have this procedure can often go home the same day, often with no narcotic pain relievers. University Hospitals was the first healthcare provider in Northeast Ohio to offer Inspire therapy.
“It’s a completely different paradigm of treatment,” says Amy Schell, MD, a new otolaryngologist and sleep surgeon at University Hospitals and Clinical Instructor of Otolarnygology at Case Western Reserve University School of Medicine. “We don’t irreversibly alter the patient’s airway anatomy. For people with more neuromuscular control issues, this might be the way to go.”
According to Dr. Schell, this kind of phenotyping of OSA patients – categorizing them by a single or combination of disease features – is the future of the field.
“Over the past several years, we’ve been working on various ways to phenotype the airway, to figure out in a particular patient, which part of their anatomy seems to be driving their obstruction,” she says. “To figure out in each patient which factors are driving their sleep apnea and then act upon those, that’s going to be the thing that’s forthcoming over the next several years. As we start to understand that more and more, I think our success rates will only improve.”
Key to the success of any OSA treatment plan, she adds, is a multidisciplinary team – such as the one in place at UH. That includes physicians from sleep medicine, otolaryngology-sleep surgery, pulmonology, family medicine, neurology, psychology, dentistry and bariatrics/weight management.
“We do have excellent resources in all the facets of managing OSA patients,” she says. “I hope we can continue to develop that as a strong multidisciplinary team.”
Dr. Schell earned her medical degree at the University of Virginia School of Medicine. She completed otolaryngology residency and sleep medicine fellowship training at the University of Pittsburgh Medical Center. Now in her second month at UH, she sees patients at UH University Suburban Health Center on Green Road, UH Parma Medical Center and a new sleep medicine-sleep surgery clinic at UH Cleveland Medical Center. She performs surgery at UH Richmond Medical Center, UH Parma and main campus.
Any discussion of surgical or non-surgical treatment for OSA, Dr. Schell says, includes the topic of the patient’s obesity.
“If you can get the weight down, it expands your menu of effective treatment options,” she says. “Even if CPAP is required, the pressures can be more tolerable.”
When treatment involves CPAP, Dr. Schell says there are options.
“There have been a lot of advancements with the equipment and the mask interfaces,” she says. “Knowing more about the nasal anatomy and upper airway anatomy can sometimes help us to find an interface that’s going to be appropriate for a certain patient with a certain anatomy. Not all CPAPs are created equal. There are also a lot of things we can do for patients, including medically and surgically treating the nasal airway, that can help them tolerate the CPAP more effectively. It’s not one treatment or another – often, we combine aspects of surgical and medical treatment to find the best combination.”
Patients benefit, too, from having a complete understanding of all their options.
“Even if we’ve decided to start with CPAP or an oral appliance instead of surgery, I like to go over the menu of treatment options with people right off the bat,” Dr. Schell says. “It helps them to know to come back. If one thing isn’t working for them, they can know that there’s a plan B, C, and D.”
Although Dr. Schell will be primarily focusing on the medical and surgical treatment of OSA, she will also be handling some general ENT cases. For more information or to make a referral, please call 216-844-6000.