More patients are seeking help for obstructive sleep apnea (OSA) and snoring, but not all respond to traditional therapies such as continuous positive airway pressure (CPAP) — and not everyone who snores has OSA.
To offer comprehensive care to this growing patient population, Duke Head and Neck Surgery & Communication Sciences (HNS&CS) is expanding access and offering the latest treatments, including sleep surgeries at Duke Health.
A Growing Need
The increase in OSA and snoring patients can be attributed to a couple of trends, said Emily Commesso, MD, Assistant Professor of HNS&CS and Sleep Surgeon at Duke Helth.
"Patients are becoming more proactive about tracking their overall health, which means we're seeing more people coming in for evaluation," Dr. Commesso said. "But sleep apnea is also increasing overall, coinciding in many ways with the increase in obesity in our country and around the world.”
Dr. Commesso joined the department in 2023 to help meet the rising demand. The first fellowship-trained sleep surgeon in North Carolina, she offers expertise that other ENT practices can’t.
A Comprehensive Approach to Treatment
Patients come to Duke Health either by referral from providers such as their sleep medicine specialist or by self-referral. Those referred by specialists often have tried other therapies that haven’t been successful. Self-referred patients may need to start with a sleep study, in which case our team coordinates with Duke’s sleep specialists to identify if a patient has sleep apnea or primary snoring — snoring that isn’t from OSA or other health issues.
After carefully reviewing a patient’s test results and performing a thorough physical assessment, the Duke Health team first seeks to evaluate all treatment options including conservative therapies, medical therapies, and potential surgical options. Whether a patient needs a CPAP or surgery, the Duke Health team can provide comprehensive care.
Patients with OSA may require a drug-induced sleep endoscopy, which allows our doctors to better identify the location of the issue causing airway blockage. This diagnostic procedure is done in a monitored and safe fashion to evaluate potential surgical options for sleep apnea.
Expanding Care Options
The Duke HNS&CS team, which includes Russell Kahmke, MD, and Matthew Ellison, MD, along with Dr. Commesso, works closely with colleagues throughout Duke and in the community — from sleep medicine and weight loss specialists to dentists — to create a comprehensive care program for each patient.
“We look at each patient as an individual and target our approach based on their unique situation,” Dr. Commesso said.
Patients who don’t respond to conservative treatments may be candidates for sleep surgery. Sleep surgeries aim to open the upper airway they include:
- Nasal surgeries, such as septoplasty and turbinate reduction, performed for nasal obstruction and may also improve CPAP tolerance
- Palatal surgeries, such as tonsillectomy, uvulopalatopharyngoplasty
- Tongue procedures, including hypoglossal nerve stimulation (Inspire therapy) and radiofrequency ablation, to address tongue-related obstruction
- Epiglottis procedures
Some nasal surgeries and radiofrequency procedures are now available in-office, offering greater convenience and lowering costs — an important factor for primary snoring patients, as health insurance often doesn’t cover treatment for that condition.
Learn more about sleep surgeries performed at Duke Health.
Improved Access to Care
In addition to bringing on Dr. Commesso to expand offerings, the Sleep Surgery team has added advanced practice provider Mary Hamlin Womble to the program. These additions allow the Duke Health team to evaluate and treat more patients for sleep problems, including more in-office procedures and expanding telehealth options.
“I think virtual options are going to give access to patients who might have to drive several hours to see us,” Dr. Commesso said. “We can conduct the initial evaluation virtually and order sleep studies or additional tests before they see us.”
The larger group also allows the Sleep Surgery team to better collaborate with colleagues at Duke. They have regular meetings to discuss cases, encouraging multidisciplinary approaches to help patients.
Creating a Destination for Sleep Surgery
With continued growth, Duke’s Sleep Surgery Program aims to solidify its reputation as a national leader in sleep surgery.
"When referring providers think of sleep surgery, we want them to think of Duke as the premier destination," Dr. Commesso said. "Our goal is to provide the most advanced, patient-centered care available, supported by a world-class team of specialists."