Efficacy of Submucosal Sodium Tetradecyl Sulfate in the Soft Palate as a Treatment of the Mild Obstructive Sleep Apnea Syndrome: A Pilot Study

Background. As described by Mair et al. in 2001, snoreplasty, the application of sclerosant agents in the palate is a promising and cheap alternative to treat snoring. We decided to try this kind of therapy for the management of mild sleep apnea. Study Design. Experimental, longitudinal, prospective, nonrandomized, self-controlled pilot study. Methods. 11 patients were included, all of them with a polysomnographic study showing an Apnea-Hypopnea Index (AHI) from 5 to 20, and with a Müller maneuver showing only retropalatal collapse. Results. We found significant decrease in the number of apneas hypopneas and oxygen desaturation as well as in the snoring index ( ), although no differences were found in the number of arousals. Conclusion. Sclerosant agents might become a relevant part in the treatment of sleep apnea, in very well-selected patients. 1. Introduction The obstructive sleep apnea syndrome (OSAS) is one of the most commonly found sleep disorders around the world. A number of studies show that it may be present in 5–20% of the adult population, and about 40 million Americans seem to be affected [1]. The obstruction in the upper airway may be present at one or many anatomical locations: the nasal septum, turbinates, tonsils, adenoids, soft palate, base of tongue, and even epiglottis, [2] and its presentation includes not only adults, given that children can be affected as well [3]. Many authors have demostrated a strong association between OSAS and a high incidence of traffic accidents, becoming one of the most important risk factors, just following alcohol [4]. OSAS has also shown to be an important factor in the development of cardiovascular conditions such as systemic hypertension and stroke [5, 6]. According to the International Classification of Sleep Disorders (ICSD, 2005), diagnosis of OSAS has to be suspected on patients complaining of snoring, astenia, cognitive disorders, and excessive daytime somnolence. Polysomnography should be performed on these patients in order to confirm the diagnosis, getting the apnea-hypopnea index (AHI) and rule out the presence of central or mixed apnea periods [5, 6]. The site or sites of obstruction at the airway should be suspected during the physical examination. The use of imaging studies like cephalometric measures, computed tomography, and magnetic resonance have been proposed, but none of them have shown to be more effective. Flexible fiberoptic nasopharyngoscopy with Müller maneuver may be a more accurate method to determine the obstructive area, despite its usefulness is still controversial [7].