Laser or Radio-Frequency: Which is better for snoring?

Fall 2002 newsletter from the Sleep Surgery Centre

At the Sleep Surgery Centre patients are encouraged to become thoroughly informed about all forms of treatment for snoring and obstructive sleep apnea and to engage fully in the decision process concerning the best treatment for them. Not surprisingly, then, the question of whether the laser assisted uvulopalatoplasty (LAUP) or radio-frequency palatal myoplasty (RPM) is the best treatment often comes up. Recently a study from France compared the two (Radiofrequency vs. LAUP for the treatment of snoring, Blumen MB et al, Otolaryngol- H&N Surgery: 126,1): the abstract (summary) of this article can be found on the publication page of this website. Thirty patients chose either radio frequency or laser treatment, 15 in each group. The RPM group each received an average of 2657 Joules of radiofrequency energy (somewhat less than a typical case receives here) over an average of 2.1 sessions. The LAUP group were planned to have a series of laser treatments, but most had only one because the pain made them disinclined to come back for their second treatment. None of the RPM group failed to complete their treatments. The results showed that both LAUP and RPM reduced snoring (by 66% and 80% respectively), and that satisfaction rates were 67% for LAUP and 87% for RPM).

Interpreting these results has its problems. First, because the LAUP group did not all complete the treatment as it was planned, several of them were only "half-treated" compared to the fully treated radiofrequency group, biasing the results in favour of RPM. Further, here at the Sleep Surgery Centre we do a single, complete LAUP treatment, removing at one session all the tissue which can safely be taken; so the "LAUP" of the study bears little resemblance to ours: a single treatment at the Sleep Surgery Centre would be expected to be much more effective than their single treatment. Finally, the patients selected their own treatment, instead of being randomly allocated to one or other group, and this renders the results more questionable.

So where does this leave us? Well first, in making the decision for any form of treatment bear in mind that each individual will have specific characteristics which make certain treatments more suitable than others. For instance, the presence and degree of apnea (or the milder "hypopnea"), the level of obstruction found on office examination, and fee-cover issues, are all examples of factors which may influence the choice. But in general terms LAUP has been shown to be effective in 60 to 95% of patients. At the Sleep Surgery Centre we use a meticulous grading system to identify the primary level of airway obstruction, and in this way we believe we can achieve a bedpartner satisfaction rate greater than 90%. RPM in this study did not achieve that.

As a guideline then we feel that LAUP remains an excellent treatment for palatal snoring and mild sleep apnea, provided that you can handle a recovery period of ten days, and especially if you can take some time off work. If that does not sound like you. RPM seems to come in a pretty close second.

From the information lab of the Sleep Surgery Centre, Inc.

All rights reserved. September 1, 2002.

Sleep Surgery Centre Inc. 303 - 2963 Glen Drive, Coquitlam, Vancouver, B.C. Canada V3B 2P7
Tel: 604-941-2344 Fax: 604-941-2455 E-mail: info@sleepsurgerycentre.com