Robson Capasso, MD has a unique view of the sleep world. Trained as a surgeon as well as a sleep medicine physician, he is also board certified in sleep medicine. Since March, he has brought that duality of purpose to Stanford’s Division of Sleep Surgery and in kind, to its Sleep Center, offering patients comprehensive diagnosis and treatment for every sleep disorder, with a main focus on sleep disordered breathing.

“We can offer anything the patient needs, from Continuous Passive Airway Pressure (CPAP) use and other non-surgical treatments for sleep disorders to any surgical intervention,” says Capasso, Clinical Assistant Professor of Otolaryngology- Head and Neck Surgery. “We have an excellent integrated program, with constant communication between our Sleep Center and our sleep surgeons.”
Capasso joined the Stanford sleep surgery team in March 2010 from the University of Miami, bringing with him expertise in the latest surgical techniques, and a tenacity for matching patients with the most appropriate treatment, be it surgery, CPAP, oral appliance, or a combination of them. Together with sleep surgery pioneer, Richard Goode, MD, Professor Emeritus in Otolaryngology, Capasso treats patients’ sleep disorders with the most appropriate and likely least invasive procedure possible.

Dedicated Sleep Medicine Specialists
In an age where sleep centers are springing up in every community, and most ENTs treat sleep issues to a certain extent, Stanford’s program offers a distinct advantage—a singular focus. “Very few ENT departments have a professional who dedicates most of his or her time to sleep,” says Capasso. “At Stanford Otolaryngology Department we have two.” Another member of the team is Dr. Sabine Girod, Chief of Craniofacial Surgery who shares the passion for sleep surgery, with focus on procedures that require facial skeleton modifications. Also, Stanford has one of the few fellowship programs in Sleep Surgery in the country and is responsible for training several renowned surgeons worldwide.

Most patients who seek treatment come in because their bed partner complains of loud snoring. Many of these patients leave with a successful cure to their snoring. But in many cases, snoring is a symptom of a greater sleeping disorder, obstructive sleep apnea (OSA). In the U.S. alone, more than 13 million people suffer from OSA. Nearly 80 percent remain undiagnosed and untreated, putting them at risk for hypertension, heart attack, arrhythmia, stroke, depression and motor vehicle accidents.

For patients with moderate to severe OSA, CPAP remains the initial treatment for most patients, Capasso explains. Stanford sleep medicine specialists take extra care to get patients well fitted for CPAP, helping them to try a variety of mask styles to find one they can tolerate.

“For mild cases of sleep apnea, treatment options are more flexible, with improvement of nasal breathing playing a crucial role in my view,” says Capasso. “I don’t push for surgery on everybody. But, there are a good number of people, who despite everything we try, cannot use CPAP or do not improve using CPAP. For these patients we look at surgery.”

Surgical Treatments for Snoring and OSA
Stanford surgeons have been using surgery for the correction of snoring and obstructive sleep apnea for over 20 years. Surgery aims to reduce anatomical obstruction in the nose, throat or tongue level, or a combination of all to maximize airway improvement.

“We have a multitude of sleep surgery techniques available,” says Capasso. But not every patient is a good candidate for surgery. “For moderate to severe sleep apnea, we have to be very careful about patient selection,” he adds. The most important factor for determining who will do well with surgery is not necessarily the severity of the sleep apnea, but the patient’s anatomy, age and weight. Obese and older patients, with some exceptions, are usually poor candidates for surgery.

As both Goode and Capasso explain, success rates for surgery vary widely, and the establishment of an appropri­ate goal – reduce disease severity, symptomatic relief, improvement in sleep quality, increase CPAP compliance - is very important. For patients with an obvious anatomical abnormality, such as large tonsils, a small jaw or both, surgical cure rates are higher.

Capasso and Goode are continuously involved with cutting edge technology, devices and surgical technique research and development. Currently they have been involved in analyzing imaging techniques in conjunction with the sleep study. “While the sleep test is a good method to tell you that the patient is not breathing well, it does not tell you where the obstruction is happening,” says Capasso. “We are evaluating how modified CTs and MRIs may help us determine who will be a good surgical candidate.”