Pillar Implants
For appropriate patients, this is one of the least uncomfortable anti-snoring procedures that can be performed in one step. Three thin braided polyester rods are inserted into the soft palate under local anesthesia in the office.
After the procedure your throat will feel uncomfortable for 2-3 days. Most people describe it as a very bad sore throat. Rarely, an implant may extrude; it can be replaced depending on your situation.
In the study submitted to the FDA, 78% of patients (and bedpartners) were satisfied with the treatment. Of these people who responded, about 90% of patients were still satisfied at one year.
Pillar for OSA
Restore Medical’s Pillar Impalnts also recently received FDA approval for mild obstructive sleep apnea. It is a viable option for select patients with mainly palatal level collapse.
Their results revealed that overall, 78% of patients experienced a decrease in the AHI. And of these “responders”, the average decrease was about 51%. However, if you re-analyze their raw data, their overall “success” rate is 35%, using a commonly accepted definition of “surgical success” (greater than 50% drop in the AHI and the the final AHI is less than 20). This number was calculated by taking the total number of “surgical success” patients and dividing by the total number of patients in the trial. Restore’s success rate of 44% was calculated by taking the total number of “surgical success” patients, divided by the total number of “responders”, which is an unconventional way of reporting results. This recalculated 35% success rate is in line with what would be expected for a lesser invasive palatal procedure than the UPPP operation (with a 40% overall success rate). Also note that 11% of these patients did not “respond”, and 11% became worse.
In addition, they only recruited patients with mild to moderate OSA (AHI < 30). Most studies on success rates for surgery usually begin with much higher numbers (AHI up to 60). So if you adjust for the average pre-op AHI, the Pillar success rate is mostly likely a slight overestimation. For this reason, potential patients should have an AHI of less than 30.
This is why a complete examination is crucial in determining if palatal narrowing is the only source of your snoring or sleep apnea. Is is accepted that tongue collapse may be responsible for most UPPP failures. Once the tongue and palate are considered together, the success rate increased to 70 to 80%. Please refer to the OSA article.
The Friedman staging system is commonly used to predict whether or not a person will respond to a UPPP alone. Based on tongue position and tonsil size, Dr. Friedman predicted with up to 80% accuracy whether the UPPP operation alone resulted in “surgical success”. For most people with OSA, their success rate was 40%, which is similar to the historical figure that’s given. This staging system is probably useful as an additional tool in selecting the appropriate method of management for OSA.
Despite my critical analysis of the Pillar success rates, this procedure is a very useful addition to the armametarium of options for snoring and sleep apnea, best reserved for select patients with mainly palatal involvement. As with any new technology, it must be used with caution and undergo further testing with rigorous scientific analysis.
Just like any of the other anti-snoring or OSA procedures, the success rate depends on choosing the right candidate, based on the anatomy.
Steven Y. Park, M.D.
Otolaryngology – Head & Neck Surgery
(212) 315-9058
