Pamplona, April 2008

The first International Symposium on the Multidisciplinary Treatment of Sleep Apnea was celebrated at the Faculty of Medicine of the University of Navarra on March 26, 27 and 28. There were 23 national and international speakers from 10 different specialties present, all of them with years of experience in the different fields that make up Sleep Apnea. The event was organized by the Sleep Unit of the University Clinic of Navarra. There were 230 participants from different medical and surgical specialties implicated in the treatment of this pathology.

During the Symposium there had been a pre-Congress celebrated on Wednesday, March 26, with a more surgical focus, where a bimaxillar and geniohyoideusadvancement as well as an uvulopalatopharyngoplasty and a genioglossus advancement had been presented by Dr. Powell and Dr. Schendel from the Sleep Surgery Center of the Stanford University. During the two following days the medical aspects of this pathology dominated, including the diagnostics, its social importance and the optimization of the treatment and the follow up. The long term results of the surgical procedure, which is being followed at Stanford, had been presented.

One calculates that there might be more than 2 million people in Spain affected by the Sleep Apnea, pathology as important as diabetes (although only 5% of the sick people have been diagnosticated even if not treated). Dr. Masa stressed the absence of resources for the correct diagnosis and follow up of those patients. There are only 20 Sleep Units in our country and these are definitely not sufficient for this number of patients taking into account that one recommends one bed with the possibility to realize polysomnographic studies for 100.000 habitants. There was also treated the adherence of the treatment with CPAP demonstrating that after 5 years only 70% of the patients continued using it. Even though CPAP is one of the treatment possibilities for this pathology there are many patients that do not tolerate it. There was discussed the necessity of an ENT and / or maxillofacial exploration of all polysomnographically diagnosticated patients before CPAP started to be used. Many of them will have a retrusive or dolycocephalic profiles where one can expect good results with a bimaxillar advancement.

Dr. Culebras from the Syracuse University and dr. Billiard from the Montpellier University talked about the stroke morbimortality of patients with Sleep Apnea and the urgency of diagnostics and treatment. They stressed the idea that this syndrome is a serious process and potentially mortal because of its complications: cardiovascular, stroke or the increase of incidence of the traffic accidents or accidents at work. The severe cases can be potentially mortal in only 10 years.

Dr. Salvador emphasized the relation between the Obstructive Sleep Apnea and the metabolic syndrome (insulin resistance, obesity, hypertension and atherosclerosis) confirming the idea that apnea increases the incidence of diabetes in those patients by itself. He pointed out the importance of the weight control as a fundamental part of the treatment – loss of 10% of weight produced the reduction of the apnea-hypopnea syndrome of 25%.

Dr. Guilleminault defined and characterized the syndrome of Obstructive Sleep Apnea in children and his speech awakened great interest. He pointed out that Sleep Apnea is as a disease with a strong hereditary behaviour – children of parents diagnosticated with apnea with dolicocephalic profiles run a great risk to inherit the same facial growth pattern and present apneas in childhood. Dr. Guilleminault insisted in the existing association between Sleep Apnea in childhood and the syndrome of attention deficit hyperactivity disorder. These children need a new ENT and orthodontic evaluation. He stressed the importance of not being conservative when doing adenoidectomies and maxillary expansions that dilate the nasal passage and solve transversal deficits at an early age.

Dr. Hatcher, oral and maxillofacial radiologist, demonstrated the applications of the cone beam computed tomography for the realization of virtual endoscopies of the superior airway and the new applications of the 3dMD software in the volumetric determination of the airway pre and post surgical and the detection of the restriction points. Dr. Hohenhorst talked about the utility of the fyber endoscopy during induced sleep with “propofol” in the detection of the restriction points during the sleep and its importance for the individualization of the surgical treatment.

There is no doubt though that the stars of the Symposium were Dr. Powell and Dr. Schendel who described the different surgical techniques of soft and hard tissues. They explained with details their procedure in two phases, the actual indications of the radiofrequency, the uvulopalatopharyngoplasty and the genioglossus advancement. Their results presentation had a great importance as they showed 10 years of follow up, in patients who have been operated (bimaxillar advancement), and the comparison with the results of other international groups. The rate of apneas has become regular, depending on the series, in between 90% and 100% of patients operated by this procedure.

Hoping that the Symposium has served us all as an update in the diagnostics and treatment of the Obstructive Sleep Apnea and that it will help to create more multidisciplinary teams that will achieve expected results, I am sending you greetings from Pamplona. Maybe some day, hopefully soon, we will make more orthognathic surgeries because of apnea than because of occlusal or esthetical reasons.

Last but not least I would like to appreciate the inestimable collaboration of our remarkable speakers, as well as to say thank you to the audience, without which it would not have made any sense to organize this event, to the companies that have supported this event and made possible the realization of the Symposium, and especially to Osteoplac Congresses for all these hours of hard work and the illusion they have worked with.