The News Sun, Waukegan, Illinois
March 5, 2001

Silent Nights

Breakthrough procedure works to prevent sleepless night

"The whole day I'd be tired," she lamented.

These days Kris, who asked that her last name not be identified, is enjoying restful nights after undergoing a new medical procedure called injection snoreplasty.

"I sleep through the night now," she said.

When faced with her dilemma, Kris visited ear, nose and throat specialist Dr. William Gatti. After a thorough examination and home sleep test, Gatti thought Kris would be a good candidate for the brand new injection snoreplasty procedure.

A low-cost alternative

Gatti is one of the few physicians in the country who offer the low-cost, low-pain alternative to the popular laser technique introduced to U.S. physicians in 1995. Injection snoreplasty is a far less invasive and painful treatment than the laser-assisted uvulapalatoplasty which involves vaporization of part of the soft palate and uvula (the dangling tissue in the back of the mouth).

The injection technique works by stiffening the soft palate with one to three injections of sotradecol into the palate tissue. Sotradecol is a sclerosing, or scarring, agent that has been used safely for more than 30 years to treat spider and varicose veins. Taking only a few minutes to administer, one sotradecol injection is applied to the patient's locally anesthetized soft palate, above the uvula. A swelling of the soft palate is experienced immediately after the injection and the patient remains in the doctor's office for monitoring for approximately 30 minutes.

Over a period of four to six weeks, the chemical causes a slight stiffening of the palatal tissue. In most cases this will prevent the fluttering of the palate that causes the snoring noise. After-effects of the injection include minor swelling and pain, which can last several days requiring a temporary diet of soft food and possibly pain medication. Despite the discomfort, most patients return to work the day after the procedure without any ill effects. Further injections may be required at later dates if the desired results are not obtained within the four to six-week period.

Mapping success rate

To date, Gatti, who has offices in Gurnee and Libertyville, has not had any repeat customers. One injection has provided the patient with the hoped-for silent nights.

Although sotradecol has been approved for oral use by the Federal Drug Administration, it has not yet been sanctioned for the use of snoring. Because injection snoreplasty has only been available to consumers for a short time, long-term effects of the procedure are unknown. While insurance does not usually cover the cost of injection snoreplasty, most snore sufferers think the $375 cost is worthwhile compared to the $1,500 expense for the laser procedure.

Before determining which procedure will work for a patient, Gatti includes a SNAP home sleep test in addition to his examination. "The SNAP test is important to me from a point of view of making an accurate assessment of if this patient is a candidate," said Gatti.

Dr. William Gatti describes to a patient what his throat will feel like after performing an injection snoreplasty at his office in Libertyville. (Photograph by Thomas Delany Jr.)

The test consists of equipment which is the approximate size of a portable cassette player. The electronic device measures oxygen levels and records snoring sound levels as well as determining where the snoring sound is originating. Highly accurate, it is also an important tool in detecting the serious sleep disorder of sleep apnea. "The SNAP test is comfortable for the patient to use at home, eliminating the need for expensive hospital sleep tests," said Gatti. Should the SNAP test determine that most of the snoring noise comes from the soft palate, and providing that the physical examination confirms this, the patient can be considered for injection snoreplasty.

Kris recently repeated the SNAP test as a follow-up procedure. She was pleased to learn that the results indicated everything had improved at least 50 percent. She still has some snoring, but the test showed that the noise was 50 percent quieter than before the treatment. Other than a slight stiffness in her palate, Kris doesn't notice much of a difference in her throat.

Not known at this time is if injection snoreplasty will improve symptoms of sleep apnea. "It is not designed to cure sleep apnea. But you have to realize every sleep apneac snores. I have a few patients who have sleep apnea and they just want to get rid of the snoring," said Gatti.

Sleep apnea can be controlled but not cured with a Nasal CPAP machine. People with sleep apnea successfully use this compact device to promote continuous breathing throughout the night.

Another success story of injection snoreplasty is longtime snorer William Rotolo of Lake Forest, who chose the snoreplasty experience over the laser procedure. The 48year-old home builder credits his wife with encouraging him to seek treatment.