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Sleep Apnea Surgery: the FOX News Interview

Sleep Apnea surgery vs. CPAP: a recent FOX News interview provides some colorful commentary on the battle unfolding between proponents of either treatment option. During the interview, FOX News interviews Dr. Jennifer Walden, a doctor who is presented to us without any information other than she is affiliated with New York City's Lenox Hill Hospital. The topic of the interview is one which we have reported here, that Sleep Apnea kills. So far, so good: an interview with a trained medical professional about the scary consequences of untreated Sleep Apnea.


But about 1.5 minutes into the interview, the interview derails into something other than an objective overview of the dangers of untreated Sleep Apnea. Here, Dr. Walden introduces treatment options, mentioning positive airway pressure as an alternative only to quickly dismiss it as some sort of impossible option because, in Dr. Walden's view, it's "very big and very cumbersome" and looks "like an elephant's snout." Ok, that's a little insensitive and surely overstated, but here's the kicker: according to Dr. Walden, CPAP doesn't "really" treat Sleep Apnea at all. Why? Because, Dr. Walden says, using CPAP, Sleep Apnea isn't "going to go away." Dr. Walden's solution? Losing weight and surgery are "more definitive ways to treat the problem." Now that goes beyond insensitive and is just plain inaccurate. Hmmmm. Why would a doctor ever want to give inaccurate information to a national viewing audience which is otherwise clueless about Sleep Apnea and hungry to do something, anything, not to die from it? A quick Google search reveals Dr. Walden is a plastic surgeon. I'll let our readers draw their own conclusions. More on this FOX News report to come tomorrow. Stay tuned...

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Comment by Richard Morgan on January 15, 2009 at 12:55pm
Mo's right. We need to lighten up. Quite honestly, I didn't listen to the video before I commented, shame on me, I just based it on what I had read in the comments. I really wasn't a big deal at all. However I stand behind my first comment about surgery. Too many needless surgeries are performed in many areas, just for the sake of money. I don't think Fox was trying belittle CPAP users. I do however, the Dr was one-sided on her views on CPAP>
Comment by The SleepGuide Crew on January 15, 2009 at 11:13am
Fab commented on this article, the full text of which is reproduced below:

I fully agree on Dr Park with his first and his latest comments. CPAP is the Gold Standard for severe sleep apnea and there will be no miracle pill or miracle surgery procedure that can challenge it for the next 10 years (see the latest proceedings from renowned leaders at the International COngress of Paradoxical Sleep last week in Lyon).

In case CPAP is not tolerated the second line option are custom made oral appliances (see latests guidelines form the American Academy of Sleep Medicine published in Chest in 2005. Surgery (and they mean mostly maxillo-facial surgery) can be considered only in very specific cases where odds of success are very high.
ENT surgery as pointed out bravely and ethically by Dr Park who is an ENT specialist is not effective or at least much less effective than CPAP or custom made oral appliances and therefore is NOT recommended for sleep apnea treatment though it can be somewhat effective at reducing the snoring.

By the way this consensus on CPAP first and then oral aplliances for severe sleep apnea and either CPAP or oral appliances for light to moderate sleep apnea is not just an american view it is also endorsed by the Swedish and the French Health Authorities - which is not always the case in medicine and proves the strength of this recommendation.

DIsclaimer: I am a bad French capitalist (yes they do exist in spite of what some media FOX? might think) who 4 years ago left the States to co-found in Lyon a company that specializes in custom made oral appliances). This being said I share Bill's opinion that it should not be us against them, there is no one (and probably will never be) miracle cure but different treatment options with a specific pecking order that is well validated by clinical studies and medical experience.
Comment by Steven Y. Park, MD on January 14, 2009 at 11:14pm
As an ENT surgeon that performs sleep apnea procedures, I cringed multiple times during her interview. The fact that she mentions CPAP blowing oxygen into your lungs was disturbing. Yes, she's stating her opinion, but in my opinion, it wasn't done professionally. She mentioned the laser procedure for sleep apnea, which is a very old procedure that hurts a lot and is found not to work very well in general. You only see this kind of information in medical websites that repeat the same outdated information over and over.

I also think she did a disservice to people with sleep apnea, especially with her derogatory remarks about CPAP.

I won't get into the whole CPAP vs. surgery discussion here—it's a long one. Needless to say, CPAP should be the first option. With good counseling, intense follow-up and support, most people can do very well with a CPAP machine. Dental devices and surgery can be used alternatively or as an adjunct. These options can be done poorly or done well—it depends on who's doing it.

As for the co-hosts, they wouldn't be mocking this issue if they did a story on cancer patients. Sleep apnea can be more deadly than certain cancers. Cancer kills one person. Untreated sleep apnea can kill an entire family in an instant if someone falls asleep at the wheel.

http://www.doctorstevenpark.com
Comment by Dave on January 14, 2009 at 8:04pm
I think the debate stems from all of our desires to hear people talk about sleep apnea in an honest way that encourages, rather than discourages, patients to learn about sleep apnea and consider all their options before treatment. In addition, those coping with sleep apnea should not operate out of fear or based on over zealous opinions of people with vested interest in their particular type of treatment. Telling someone they will look like an elephant and become undesirable romantically if they are treated, is not acceptable. Most importantly, because of all these negative forces at work, patients should always be encouraged not to give up!

Some of below should be checked for accuracy, but maybe the site should have a mission statement or statement of principles. I think if we try hard, we can all agree and help guide discussions and keep them more informative rather than preaching/debating points we can all agree on with a little effort.

Some thoughts:

1) Obstructive Sleep Apnea (OSA) is the most common form of Sleep Apnea. Most people when discussing 'sleep apnea' are referring to OSA. We should encourage the distinction of OSA from other forms of Sleep Apnea and any other sleep disorder for that matter.
2) CPAP has a reasonable chance (can we get #s?) of successfully treating OSA. We should have two phrases (maybe we can do better) - perhaps 'Complete Treatment' and 'Treatment.' This is an important distinction if we are going to talk about this in an objective way. Some people might not be able to get their AHI below 5 (aka 'Complete Treatment'), however, they are being treated as well as possible and are adding years to their life because of their treatment. The goal is to encourage the best long-term outcome for the patient
3) Surgery has a low chance of 'curing' sleep apnea. X% of patients that have OSA, have an AHI < 5 after surgery.
4) Anyone, no matter what their title, who preys on people's fear, uncertainty, or doubt to persuade you to a course of treatment, before explaining all other options and risks in an unbiased fashion is not a true professional.
5) Fear can only be used to inform people that 'Sleep Apnea Kills.' People should be afraid of the repercussions of not being treated for sleep apnea. Fear should never be used in any other way - period.


We should try to reach out to these people who appear on TV and explain, in a soft, understanding, and informative way why the way they talked about apnea has side effects that impact people in ways they don't realize. After non-bashing dialogue, most will be ashamed and be more careful in the future. In addition, in the end they may become allies in true understanding, rather than the enemy.

Up until about 1:35 in, it is pretty informative and operates how a tv news brief should...but after that, it lacks depth and can be misinterpreted. One thing she said I never heard was 'treatment starts with behavior modification.' I've never heard anyone say that before. I've heard people say if you lose/gain a lot of weight, you should get another sleep study, but not ignore the issue until you lose weight - which some might interpret her statement to mean

Did you hear some of the quotes in there....horrible! there are plenty in there

-after explaining what CPAP is she says:
'It's hard to do and people don't want to really do that'
'It treats you, but it is big and really cumbersome and looks like an elephant snot'

-When asked are the masks becoming more popular now?
'They don't really treat it in that it's not going to go away'
...in above she confuses people......cpap & masks can treat apnea fully.....of course, using a cpap machine does not change your anatomy. Of course she mentions in a way that encourages people to '....change your anatomy by some sort of surgical procedure.....'

heard the phrase:
'montauk monster'

at the end, the female cohost says mockingly:
' I just wonder how you bust that out on your honeymoon'
'that's only something you can bust out if you are married'
Comment by Richard Morgan on January 14, 2009 at 7:55pm
FOLLOW THE MONEY!!!!!! If surgeons don't perform operations, they don't make money.
Comment by sleepycarol on January 14, 2009 at 7:00pm
Hmmmm - she refers to "new" studies linking health problems to sleep apnea. Let's see -- this isn't "new" information and I didn't hear her make any "new" references to "newly" learned information but what she did present was information that has been known for quite a long time. I know of some cpap users that have been on the hose for 10 years or so.

Hmmmm -- losing weight or behavior modifications are mentioned prior to cpap usage. While you are losing the weight and training yourself not to have apneas -- you should do what -- keep having them? As we all should be aware that losing weight and training ourselves to sleep on our side is not very effective for the vast majority of patients. Might work if you have mild sleep apnea and no real destats in your oxygen levels -- but I wouldn't want to gamble on this if it were me (I have severe sleep apnea and do destat in oxygen levels).

Well let's play up how inconvenient cpap usage is!! It looks like an elephants nose!! It is big and bulky and just plain unattractive. And let's not forget it blows OXYGEN (she repeated more than once) on our face through the mask. Well let's see -- I am afraid the good doctor is wrong on this one as mine blows AIR!! She sure isn't well versed on cpap treatment is she? Granted some patients are hooked to an oxygen feed -- but they have other conditions that warrant the added oxygen -- the cpap doesn't provide it nor can it -- it has to be adminstered by other means via the cpap.

No mention of the fact that surgery often fails. The success rate of surgery is not very high. It can often lead to worse problems.

I have a co-worker tell me yesterday he is pretty sure he has sleep apnea. Bet he watched this (I am going to inquire tomorrow at work) since he was stating some of these "facts" yesterday at work. I thought he was blowing smoke -- but it appears she made an impact on one unsuspecting sole if he did get his info from this broadcast. Said that he needed to lose weight and could train himself to not have as many apneas. I told him I didn't think it was going to "fix" him. He then stated that well he would have the surgery done as it was a "cure". I told him I used a cpap and he said he couldn't have "one of those things hanging from his face".

How sad that many will take her info and end up suffering from many of the same symptoms she was stating sleep apnea causes due to the misinformation she has provided.

I DO think there is a time and place for surgery depending on circumstances and your situation. I would want a 1st and 2nd opinion and would not do anything that would further jeopardize my health. I do think that the surgery will evolve and become better over time to where it will have a far greater success rate and the methods of treating sleep apnea will have to be redefined -- but it ain't here yet. Just my own opinion.
Comment by Heidi on January 14, 2009 at 6:43pm
Well, hmmmm..my husband is a 35 year old man in good health. He is 6'5" and weighs 175 lbs.. I would say his BMI is probably 12 (lol)...he's had the surgery and he's not overweight...I guess according to this Dr. he should be cured.

Someone needs to tell his airway...
Comment by The SleepGuide Crew on January 14, 2009 at 2:04pm
I agree with Bill and Irma that surgery is one option, and that it can be a good one for certain people. But when I listen to the part of the video starting at about 1.5 minutes into it, red flags went off for me. I value both your opinions, and would love to hear from others --- maybe i'm way off base here. has happened before. will happen again. just not convinced i am this time.
Comment by Irma Kulikowski on January 14, 2009 at 1:55pm
Ok, I cannot help but to say something about it. I do agree with Bill to a point. CPAP is 100% effective, and overall painless. I have had several patients who did have surgery done in the hopes that they did not have to use CPAP. After recup. from an extremely painfull surgery, some patients have worst sleep apnea than what they experienced before and are still put on CPAP, most of the time on a higher pressure. I would say, if surgery is the way to go for you, talk to others, do your research !!!
When you have sleep apnea, losing weight is a very hard thing to do. Again, it's so easy for someone to say, " you need to lose weight". I am sure that every overweight person is aware on what the consequences are of being overweight, but actually doing it especially when you have sleep apnea is not an easy task.
I do believe that we need to be advised what is out there for treatment options and that the medical community needs to give more education on sleep apnea as well as treatments for every individual out there.
Comment by The SleepGuide Crew on January 14, 2009 at 1:16pm
Ed, here's the link: http://www.youtube.com/watch?v=D1TyKlpiMII

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