Otolaryngology
Head & Neck Surgery

Stanford Sleep Surgery

Contact Information

Appointments
(650) 723-5281

NEW Appointments
(650) 725-3009

Location
450 Broadway Street
Pavillion B, 2nd Fl., B21  
Redwood City, CA 94063
Driving Directions

Business Hours
Monday - Friday
8:00 am - 5:00 pm

FAX
(650) 725-6685



“ I didn't know I could breathe like this.” – Watch Christian's Story



At Stanford Sleep Surgery, our pediatric and adult sleep surgeons work closely with our patients and the Stanford Sleep Disorders Clinic, offering background, experience, structure, state-of-the-art procedures, and most importantly, available facts about all treatments to help patients achieve a better quality of life.

 

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Healthy Living

Dr. Capasso's article on treating OSA is featured in the Huffington Post.
Read Dr. Capasso's article »

 



A Patient's Guide to Obstructive Sleep Apnea (OSA)


WHAT IS OBSTRUCTIVE SLEEP APNEA?

Obstructive sleep apnea (OSA) is a disorder in which breathing is repeatedly interrupted or decreased during sleep when muscles in the throat and tongue fail to keep the airway open despite efforts to breathe, preventing air to flow into the lungs and causing oxygen starvation.

When this occurs, sleep becomes a threat to life, the brain is required to momentarily awaken and breathing can be restored. In some individuals the brain has a very low tolerance to decreased airflow even if the airway is not intensely compromised, with resulting frequent arousals and sleep disruption.

 

WHAT ARE THE SYMPTOMS OF OSA?

This process in which breathing stops and starts can be repeated up to hundreds of times during one night. The combination of disturbed sleep and oxygen starvation may cause:

- Daytime sleepiness and tiredness
- Morning headaches
- Cognitive impairment
- Insomnia

Also, snoring is strongly associated with OSA, resulting in one of the most common reasons why patients search for treatment in the first place. However, it is worth pointing out that not all who snore have OSA and vice-versa. That’s why the best way to discover and treat this important problem is with a thorough evaluation by a sleep medicine physician/surgeon in conjunction with a sleep test.

 

HOW DO I KNOW I HAVE OSA?

The gold standard for diagnosis is a Polysomnography (PSG), or, sleep study. This test is performed while the patient is asleep at a sleep laboratory, and monitors brain waves, blood oxygen levels, heart rate and breathing, as well as eye and leg movements. A home monitoring device may be a useful alternative for some patients under the guidance of a knowledgeable sleep professional.

However, the sleep test itself does not provide the location of the obstruction, so evaluation methods of the upper airway are necessary to identify potential sites of collapse that lead to OSA.

Nasopharyngoscopy is an office procedure in which a flexible fiberoptic endoscope is introduced through the nose and throat to observe anatomical structures that narrow the airway and compromise airflow and cause snoring.

Sleep Endoscopy is similar to Nasopharyngoscopy, however it is performed under mild sedation (with an hypnotic drug, such as propofol) and it is an outpatient procedure. The objective of this test is to reproduce what occurs to the patient’s upper airway in a sleep state, and identify structures and areas causing the obstruction.

Still under our research protocols, imaging methods such as computadorized tomography scans (CTs), awake and sleep magnetic resonance imaging (MRI) may provide useful information as well in select candidates. CTs are routinely used in the pre-operative evaluation of patients who undergo any surgery that involves the facial skeleton such as maxillomandibular advancement.

These tools should be used together to establish a diagnosis and guide the physician’s decision-making towards the appropriate treatment for each patient.

 

partially blocked airway

Left: Narrowed airway in OSA patient | Right: Airway on normal patient

blocked airway during sleep
Airway blocked during sleep

 

 

WHY TREAT MY OSA?

There are three main reasons why we treat OSA:

      Social Factor:
      Snoring is frequently a source of distress for both the patient and their bedpartner at night.

      Health Risks:
      The drop in oxygen levels at night has been associated with increased risk of high blood pressure, cardiac arrhythmia(s) and stroke. OSA has been described as causing insulin resistance, which may cause difficulty of glucose control in diabetic patients and achieving weight loss.

      Neurocognitive Symptoms:
      While it varies in individual patients and subject to interaction with other ailments such as lack of sleep and psychological comorbidities, it is generally accepted that sleep fragmentation prevents the brain from having complete restorative sleep and may result in daytime sleepiness and drowsiness, deficits in attention, concentration, memory and executive functioning. Worsening of mood symptoms and increased risk of automobile accidents have also been described in association with OSA.

factor pyramid for treating OSA



Treatment Options

Once the diagnosis of obstructive sleep apnea (OSA) is established, Stanford Sleep Surgery believes the patient should be included in deciding an adequate treatment strategy.

Non-surgical treatments include Continuous Positive Airway Pressure (CPAP), positional therapy, use of oral appliances, nasal resistors, oropharyngeal exercises, and behavioral measures, including weight loss when indicated, frequent physical exercise, avoidance of alcohol and sedative medication before bedtime.

 

simpler anatomy of the airway
Upper airway structures usually targeted in sleep surgery

 

Continuous positive airway pressure (CPAP) remains the primary treatment for most adults with obstructive sleep apnea, however some patients don’t accept or cannot tolerate it, or have primarily correctable upper airway anatomic problems that can be causing the obstruction.

For these cases the advances in upper airway surgical techniques and appropriated patient selection can offer a definitive solution for OSA. In other cases surgery can be part of a comprehensive approach, improving the severity of obstructive sleep apnea and/or making the use of CPAP or oral appliances more tolerable. Surgery aims to reduce anatomical obstruction in the nose, throat, tongue, or more commonly, a combination of all to maximize airway patency. In some cases, the facial bones are inadequately positioned, and a more extensive procedure may be necessary. The goal is not solely to cure OSA, but to reduce snoring and cardiovascular disease risk, to recover sleep quality and decrease neurocognitive symptoms resulting in overall improvement in quality of life.

Importantly, a detailed clinical and endoscopic - and in some cases radiologic evaluation - in conjunction with the sleep test will provide us with the available data to decide with the patient what is the best approach, in an individualized manner.

OSA generally has various anatomical causes with multiple potential levels of airway obstruction; therefore, many different surgical procedures have been developed for its treatment and usually yield better results than a single-level surgery.



Your First Visit : What to Do to Prepare

Adult patients: please complete this online questionnaire before you come in.

Read the Center for Sleep Science and Medicine's advice on how to prepare for your consultation, your overnight sleep study, or your Insomnia Program (CBTi) appointment.

 



After Your Surgery : Post-Operative Instructions

 



Physicians


Robson Capasso, MD, FAASM

Robson Capasso, MD

Robson Capasso is currently the Director of Sleep Surgery and Assistant Professor of Otolaryngology and Head and Neck Surgery at Stanford University School of Medicine.

His quite extensive and unique training includes medical school and otolaryngology residency in Brazil, and further residencies and fellowships in head and neck and microvascular surgery, neurosciences and sleep medicine.

Dr. Capasso has published and reviewed book chapters, articles and original papers in peer-reviewed journals, and has been an investigator on diagnostic evaluation, and surgical management of obstructive sleep apnea patients. The global recognition of his work is often associated with one of his favorite tasks: lecturing and trading knowledge around the world.

His contact with diverse healthcare systems in several countries combined with his expertise in education led to involvement with Stanford University students interested in the development of new biomedical technologies to target the complex task of improving sleep apnea evaluation and treatment.

 

Stanley Yung Liu, MD, DDS

Dr. Stanley Liu, MDStanley Yung Liu is an Assistant Professor in the Department of Otolaryngology – Head and Neck Surgery at Stanford University School of Medicine.

Dr. Liu was first introduced to sleep-related disorders as an undergraduate at Stanford. He obtained both medical and dental degrees from the University of California – San Francisco (UCSF). He also completed his general surgery internship and oral and maxillofacial surgery residency at UCSF. During clinical training, Dr. Liu spent a year at the National Institutes of Health as a Howard Hughes Medical Institute (HHMI) Research Scholar. He also completed the Advanced Training in Clinical Research fellowship at UCSF. Most recently, he was the Stanford sleep surgery fellow under the joint tutelage of Dr. Robson Capasso and Dr. Robert Riley.

Dr. Liu is focused on optimizing the perioperative experience of sleep apnea patients, particularly with those requiring maxillomandibular advancement (MMA). He has been combining surgical techniques perfected by Dr. Nelson Powell and Dr. Robert Riley (pioneers of the MMA surgery) with the latest maxillofacial surgical technology. He has a number of ongoing research studies on MMA surgery, with emphasis on predictors of surgical success.

 

Carlos Torre, MD

Dr. Carlos Torre, MDCarlos Torre is currently a clinical instructor in the in the Department of Otolaryngology – Head and Neck Surgery at Stanford University School of Medicine.
Dr. Torre obtained his medical degree at the University of Puerto Rico, School of Medicine. During this time he spent a year at the University of California San Francisco, where he completed the Advanced Training in Clinical Research fellowship. It was then that he was first exposed to sleep surgery, which continued to be the focus of his interests during his residency training in Otolaryngology-Head and Neck Surgery at the University of Puerto Rico. Next year, Dr. Torre will become a sleep medicine fellow, where he will learn to combine his medical and surgical skills to treat a wide-array of sleep disorders.
Dr. Torre is interested in the individualized evaluation and treatment of sleep apnea patients. His research is also focused in better understanding the short-term benefits of treating sleep disorders and how it improves overall performance of specific patient groups. Finally, Dr. Torre is working to find solutions that enhance the surgical experience by decreasing pain and post-operative complications.

 

 

Medical Education and Training
For information about clinical instructorship and fellowship programs in Sleep Surgery at Stanford, see the Instructorship / Fellowship page.

 

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