Laser Snoring and Sleep Apnea

Reduction Treatment

Er,Cr:YSGG

Pilot Case Presentation

Jaana Sippus DDS, M.Sc. PhD.cand.
 Laser Snoring and Sleep Apnea
Reduction Treatment

• Introduction
• Materials and Methods
• Results
• Conclusion

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Screenshot of a PSG system showing a central apnea. Wikipedia

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

There are three forms of sleep apnea:

Central (CSA),
Obstructive (OSA), and
Complex or mixed sleep apnea

(i.e.. A combination of central and obstructive) constituting 0,4%, 84% and 15% of
cases)
Morgenthaler TI, Kagramanov V, Hanak V, Decker PA (September 2006).

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

What is an Obstructive Sleep Apnea (OSA)?

ImTheraMed™

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

The severity of sleep apnea is determined by dividing the number of episodes of

apneas and hypopneas lasting ten seconds or more by the number of hours of
sleep. The resulting number is called the Apnea-Hypopnea Index, or AHI.

AHI# Condition

Below 5 No OSA

5-15 OSA

15-30 Moderate OSA

Over 30 Severe OSA

ImTheraMed™

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Symptoms related to Obstructive Sleep Apnea

By American Association of Oral and Maxillofacial Surgeons (AAOMS)

• Snoring with pauses in breathing (apnea)

• Excessive daytime drowsiness
• Gasping or choking during sleep
• Restless sleep
• Problem with mental function
• Poor judgment/can't focus
• Memory loss
• Quick to anger
• High blood pressure
• Nighttime chest pain
• Depression
• Problem with excess weight
• Large neck (>17" around in men, >16" around in women)
• Airway crowding
• Morning headaches
• Reduced libido
• Frequent trips to the bathroom at night

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Why to treat OSA?

- hypertension & heart diseases often
related to OSA
- 77% of male and 64% of female stroke
patients have OSA
- cardiovascular deaths (estimated
30.000)
- risk for car accidents due to
daytime drowsiness
- divorces due to severe snoring
Wikipedia

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Etiology
• Overweight
• Deformities of the nasal septum or nose
• Pregnancy
• Polyps and cysts
• Malignant tumor
• Nasal congestion
• Swallen adenoids and tonsils
• Swelling of the muscular parts in upper airways
• Use of alcohol, antihistamines or sleeping pills

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Treatments Options:
• Oral appliances
• Continuos positive airway pressure
–CPAP
• Palatal implants
• Uvulopalatopharyngoplasty –
UPPP
• Laser assisted uvulopalatoplasty –
LAUP
• Radiofrequency tissue ablation
• Alternative medicine
(Wikipedia)

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

• Introduction
• Materials and Methods
• Results
• Conclusion

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

• Laser Treatment Option:

● Non ablative Er,Cr:YSGG tightening of uvula, soft palate and
surrounding tissues.
● No anesthesia – no needles

● No pre- or post-op pain

● Three 15-20 minute sessions over 2 months
● Immediate results from the 1st treatment

(in average 50% reduction)

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Exclusion Criteria
* Pregnancy
* Blood disease (Leucopenia, Leukemia, Anemia)

* Patients having therapies with photosensitive drugs

* Epilepsy (?)
* Malign tumor
* TMJ disorders
02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.
 Laser Snoring and Sleep Apnea
Reduction Treatment

Treatment method
A fractionated laser beam is used at minimally invasive
settings:
- The laser beam is fired at soft intraoral tissue with
repetition rate of 5 Hz
- The laser beam is manually delivered across the target,
either vertically or horizontally (depending on the
region)
- 10 passes are performed across each region (with 50%
overlap)
- The treated tissue is thermally processed and
consequently, it shrinks
(factory protocol)

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Treatments were done with Er,Cr:YSGG 2790nm laser,

using
fractional handpiece with following settings:
• Frequence = 5 Hz
Power= 2W
• Overlap: 50%
• Passes: 10 per area
(if needed, finish with additional 2)

• Sessions: 3, two weeks intervall

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Patient Classification

Mallampati classification

Class 1: Full visibility of tonsils, uvula and soft palate

Class 2: Visibility of hard and soft palate, upper portion of tonsils and uvula
Class 3: Soft and hard palate and base of the uvula are visible
Class 4: Only Hard Palate visible

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Treatment protocol
• Interview (Complete the Questionnaires, describe the procedure
and post-treatment period, establish possible contra indications,
establish treatment schedule 1-15-45 days)
• (Polysomnograph – if possible)
• Photo of oropharynix (definition of Malampati type)
• Protection of the patient and the stuff (laser goggles)
• Irradiation with Er:YAG laser
• Photo of oropharynix
• (Polysomnograph – if possible)
• Post treatment recommendation

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Regions to be treated
1 and 3:
anterior pillar extending to the outer
face up to the retromolar region and
posterior third of the cheek
2 and 4 :
soft palate and uvula with lower part
of hard palate
5 and 6 :
posterior pillars and tonsils
7 and 8 :
lateral and bottom of the tongue
Jugoslav Jovanović, DDS, LAHA Expert clinical lecturer

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

• Introduction
• Materials and Methods
• Results
• Conclusion

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

• Patient no1 pre-op

RepairSnore treatment
Class IV

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Patient no1 pre-op RepairSnore T Patient no1 post-op 1xT

Class IV class III

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Patient no1 pre-op RepairSnore T Patient no1 post-op 2xT

Class IV Class II

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Patient no1 pre-op RepairSnore T Patient no1 post-op 2xT

Class IV Class II

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

• Introduction
• Materials and Methods
• Results
• Conclusion

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Laser Snoring and Sleep Apnea
Reduction Treatment

Conclusions
RepairSnore is:
- Safe and efficient therapy for significant
improvement in snoring and sleep apnea
- Minimally invasive treatment; no special
preparation or post-op therapy
- No anesthesia is needed – painless
- Quick and easy treatment
- “Walk-in walk-out” treatment; no need for steril operational field
- High satisfaction among patients
- Long lasting effects – previous studies
- Effective 24/7

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

• REFERENCES
• 1. Jovanovic J. NightLase TM - Laser-Assisted Snoring and Apnea Reduction, 9 Months of Experience (Summary), LA&HA – Journal of Laser and Health Academy
Volume 2011, Number 1, Page S11.
• 2. Aston Acton Q. (2013) Anhydrides – Advances in Research and Application, © 2013 by Scholarly Editions TM.
• 3. Arias MA, Garcia-Rio F, Alonso-Fernández A, Mediano O, Martinez I, Villamor J. Obstructive Sleep Apnea syndrome affects left ventricular diastolic function:
effects of nasal continuous positive airway pressure in men. Circulation. 2005 Jul 19;112(3):375-83.
• 4. Miljeteig H; Hoffstein V, Cole P. The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea. Laryngoscope. 1992 Oct;102(10):1150-2.
• 5. Guilleminault C, Eldridge FL, Tikian A, Simmons FB, Dement WC. Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Arch Intern
Med. 1977 mar; 137(3):296-300.
• 6. Pataka A, Riha RL. Continuous positive airway pressure and cardiovascular events in patients with obstructive sleep apnea. Curr Cardiol Rep. 2013
Aug;15(8):385.
• 7. Tamanna S. Gerasi SA. Major sleep disorders among women: (women’s health series). South Med J.2013 Aug;106(8):470-8.
8. Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea
• syndrome. Eur J Intern Med. 2012 Oct;23(7):586-93.
9. Grandner MA, Patel NP, Jean Louis G, Jackson N, Gehrman PR, Perlis ML Gooneratne NS. Sleep related behaviors and beliefs associated with race/ethnicity in
women. J Natn Med Assoc.
• 2013 Spring;105(1):4-15.
10. Sullivan CE, Issa FG, Berthon-Jones M, Eves L, Reversal of
• obstructive sleep apnoea by continuous positive airway pressure
• applied through the nares. Lancet. 1981 Apr. 18;1(8225):862-5. 11. HicklinLa,TostevinP,DasanS.Retrospectivesurveyoflong term results and patient satisfaction
with uvulopalatopharyngoplasty for snoring. J Laryngol Otol. 2000
• Sep;114(9):675-81.
12. Krespi YP, Pearlman SJ, Keidar A. Laser assisted
• uvulopalatoplasty for snoring. J Otolaryngol.1994 Oct;23(5):328-
• 13. Simmon FB, Guilleminault C, Miles LE. A surgical Treatment for
• snoring and Obstructive Sleep Apnea. West J Med. 1984 January;
• 140(1):43-46.
14. Coleman SC, Smith TL. Midlinen radiofrequency tissue reduction
• of the palate for bothersome snoring and sleep-disordered breathing: A clinical trial. Otolaryngol Head Neck Surg. 2000 Sep; 114(9):675-81.
• 15. LindmanR,BondemarkL.SwedDentJ.Areviewoforaldevices in the treatment of habitual snoring and obstructive sleep apnoea. 2001;25(1):39-51.

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.

 Thank You for your attention !

Dr. Jaana Sippus 2018 www.laseredu.fi e-mail: jaana.sippus@netikka.fi

02/08/2021 Jaana Sippus DDS, MSc, PhD.cand.