OBSTRUCTIVE SLEEP APNEA
Randall T Weingarten MD
Sleep Medicine, Sleep Disorder, Sleep Disorder Centers
Obstructive sleep apnea occurs when collapse of upper airway tissues during sleep causes a temporary but complete cessation of airflow lasting 10 seconds or more. This results in lower amounts of oxygen in the blood, causing the heart to work harder. When the oxygen level drops, the body responds by waking the patient up enough to open the throat and gasp for air. Apnea patients may experience 30 to 300 such events per night. As the result, their sleep cycle is disrupted and patients feel poorly rested despite spending adequate time in bed. Over time, if left untreated, obstructive sleep apnea increases the risk of developing hyprtension, heart attacks, strokes, diabetes and other medical problems.
Snoring associated with witnessed episodes of breath pauses or daytime fatigue should be evaluated for possible obstructive sleep apnea. The breathing passages of the nose and throat should be carefully evaluated for possible structural causes of snoring and apnea. Nasopharyngoscopy is usually performed (examination of the nasal cavity and throat with a fiberoptic telescope) and most heavy snorers are referred for a polysomnogram (sleep study).
Medical and surgical treatments exist for snoring and obstructive sleep apnea.
Medical treatment options include:
Alcohol and sedative avoidance
Sleep position training
Continuous Airway Positive Pressure (CPAP) machines
A custom-fit oral appliance worn during the night
Surgical treatment options include:
Nasal surgery – straightning of the obstructing nasal septum, reduction of inferior turbinate’s, nasal valve surgery
Palate procedures – stiffening of the soft palate using radiofrequency or pillar implants
Uvulopalatopharyngoplasty (UPPP) – trimming the palate and tightening the sidewalls of the throat. This procedure may be combined with tonsillectomy.
Genioglossus advancement – advancing a portion of the jaw and tongue forward
Hyoid suspension – tightening the walls of the throat
Maxillomandibular advancement – moving the upper and lower jaw forward
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