Case 1 – Overtreatment by ‘Internationally Renowned’ Sleep Surgeon
A 38 year-old male patient (Mr I T, NRIC Sxxxx764E) presented to a self-proclaimed ‘internationally renowned’ Singapore sleep surgeon with snoring for the past few years. His wife was upset with having to put up with nightly snoring that affected her ability to sleep. He did not give a history of choking spells, morning tiredness or daytime sleepiness. He did have nasal obstruction from a sensitive nose not treated with medication. A nasopharyngoscopy was performed and the patient was told to have swollen turbinates, narrow palatal airway and large tongue base. His tonsils were small. A home-based sleep study with the Watchpat 200 was arranged for the patient the same night. The results of the study are shown below (Figure 1). It shows an Apnea-Hypopnea Index (AHI) of 5/ hr, Respiratory Distress Index (RDI) of 12/ hr and lowest oxygen saturation level of 87%. By definition, this constitutes borderline normal to mild obstructive sleep apnea (OSA).
The patient was informed that he suffered multiple desaturation episodes (seen by the circles drawn on the sleep study) and required surgery to widen his nasal passage, open his palatal opening and pull the tongue forward with a suture. He was informed that the surgery would take close to 3 hours and that he would be required to stay in hospital for one to two days. The whole event would cost up to SGD25000.
Mr I T had doubts about what he was told and sought a second opinion with Dr Chee. He was told that he did not suffer severe OSA based on the sleep study results. He was offered treatment for nasal obstruction with radiofrequency turbinate reduction which was performed in the office under local anesthesia. Six weeks later, with a clearer nasal passage, Mr I T reported sleeping much better and his snoring had resolved completely.
Patients should always seek a second opinion when they feel uncomfortable with what they have been told, regardless of whether the specialist is ‘internationally renown’ or not. The patient was told to have major surgery for relative mild symptoms and mild OSA. He felt uncomfortable with the recommendations made and sought a second opinion. Mr I T saved himself much pain, suffering and costs that would have come with major surgery and solved his problem with a minor and painless procedure that was done under local anesthesia in the clinic.