About California Sleep Institute

As of June 26th, 2008, CFARS is now the California Sleep Institute.

The Facial Reconstructive Surgical and Medical Center was developed by Doctors Nelson Powell and Robert Riley. They are internationally-renowned pioneers in the surgical treatment of Obstructive Sleep Apnea Syndrome (OSAS). Their education, training and experience are extensive, with each holding both a D.D.S. and an M.D. degree. Their training includes Head and Neck Surgery, which both doctors completed at Stanford University Medical Center in the early 1980's. It is here that they met Doctor William Dement, the father of Sleep Medicine and Doctor Christian Guilleminault, a world leader in Sleep Disorders, who was the first to describe Obstructive Sleep Apnea Syndrome (OSAS). The collaborative efforts of these four physicians led to the establishment of the current standards of practice for sleep medicine and surgery at Stanford University.

These physicians recognized that in Obstructive Sleep Apnea Syndrome the entire upper airway is diffusely involved in the majority of patients. This explains why so many patients do not respond favorably to isolated throat surgery (uvulopalotopharyngoplasty, or UPPP) since this surgery only treats one area of obstruction. Therefore, they developed multiple surgical procedures to specifically address the other areas of potential obstruction, the most important of which was the base (back) of the tongue. They subsequently developed a Phased Surgical Protocol which offered a systematic and comprehensive approach for those suffering from Obstructive Sleep Apnea Syndrome. This protocol is staged in such a manner as to minimize the amount of surgery performed in any one phase, thus minimizing the risk of unnecessary surgery. A sleep study is used to evaluate the results from each phase.

The results of this surgical protocol have been widely published in peer reviewed medical and surgical journals. This conservative protocol has been successfully used by Drs. Powell and Riley to treat thousands of patients over the past 24 years. It is now widely recognized as a standard of care throughout the world. As part of this conservative protocol, each patient is encouraged to undergo medical treatment before surgery is considered. The mainstay of medical management is nasal continuous positive airway pressure (CPAP). Those patients who cannot tolerate nightly use of this device may be candidates for the staged surgical protocol.

Unfortunately, the medical and surgical interventions presently available all have their individual drawbacks. Not all patients can tolerate or remain compliant using nasal CPAP. Surgery, like medical management, is not always an option for all patients. This may be due to preexisting medical conditions that would increase the risk of surgery. Other limitations may include fear of surgery, concern over pain and discomfort, loss of work or income during recovery, advancing age, and/or cost.

Despite the success of their surgical protocol, the team at Stanford has continued to search for a less invasive method of treatment. In mid-1994, Drs. Powell and Riley investigated the possible application of radiofrequency energy, an emerging new technology, for the treatment of Obstructive Sleep Apnea Syndrome. They, along with their team, collaborated with engineers who had extensive knowledge and experience with this technology. Radiofrequency had not previously been used to treat the delicate soft tissue of upper airway obstruction in patients with OSAS. However, it had been successfully used for several decades in the fields of cardiology, oncology, neurology, and urology.

This research team felt that radiofrequency held potential as a minimally invasive treatment for Obstructive Sleep Apnea Syndrome but since it had not been previously applied to the delicate soft tissues of the upper airway, a series of experimental and investigational studies were undertaken. This began with animal studies designed to better define the basic science of radiofrequency and assess safety parameters, and then progressed to human clinical trials. Each clinical trial was done in a step wise fashion, much like the doctor's surgical protocol, and allowed them to develop algorithms to manage the energy, and to assess the limits and potential risks of the procedure. Four scientific studies were completed over a four year period. The results substantiated that radiofrequency can now safely treat portions of the upper airway including the nose, palate, and tongue base for nasal airway obstruction, snoring, and Obstructive Sleep Apnea Syndrome.

This new technology gives most patients yet another major choice in the treatments available for this condition. It is an option that can, in most cases, be offered as an outpatient procedure in the office or hospital, and requires minimal time in treatment (actual treatment time of 2 to 10 min depending on the site) with little to no loss of work time. Minimal, if any, pain medication is required, and in the long run the procedure has proven to be cost effective.

In addition to the above our center is currently working on other potential methods of treating Sleep-Disordered Breathing and will continue to develop new treatment modalities for the future.

Due to an increasing awareness of Obstructive Sleep Apnea Syndrome by the public and physicians, the establishment of specialized treatments centers such as the one developed by Drs. Powell and Riley remains a critical necessity, as does the expansion of existing centers.