Jubilee Hospital, Trivandrum,Kerala
Snoring and OSA-live or Die
Snoring and Obstructive Sleep Apnea(OSA) are poorly understood complex disease which can kill you if untreated over a period time. Live or Die
I have been treating patients with Obstructive sleep apnea and snoring by Laser and Coblator since 1996. Several hundreds of patients have been cured from this complex illness which is not well understood not only medical profession but also lay people.
Most of these patients are “silent” sufferes ending up as cardiac patients at the end or living a miserable life. Some do get on with CPAP rest of their life and not aware of any alternate treatment.
From my experience over many years doing surgery in these patients, if they have no alternative except live a life hooked on CPAP (CPAP dependency), better try to get the Laser/Coblator surgery to get rid of the obstructive pathology in the upper airway by an experienced ENT/Laser surgeon .
Let me give a brief overview about the Snoring and OSA problem.
Snoring is not a Joke
People who snore loudly are often the target of bad jokes and middle of the night elbow thrusts; but snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.
It is important to distinguish between snoring and OSA. Many people snore. Some social snoring. Everyone has heard stories of men and women whose snoring can be heard rooms away from where they are sleeping.
Snoring of this magnitude can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one’s own snoring. But, snoring does not always mean OSA; sometimes it is only a social problem. Still, even a social inconvenience can require treatment, and there are several options available to chronic snorers.
Symptoms of Obstructive Sleep Apnea
Those who have OSA are often unaware of their condition and think they sleep well. The symptoms that usually cause these individuals to seek help are daytime drowsiness or complaints of snoring and breathing cessations observed by a bed partner. Other symptoms may include:
and Snoring with pauses in breathing (apnea)
and Excessive daytime drowsiness
and Gasping or choking during sleep
and Restless sleep
and Problem with mental function
and Poor judgment/can’t focus
and Memory loss
and Quick to anger
and High blood pressure
and Nighttime chest pain
and Problem with excess weight
and Large Collar Size(>16″ around in men, >15″ around in women)
and Morning headaches
and Reduced libido>impotency>Low sperm count
and Frequent trips to the bathroom at night
Diagnosis of OSA
Unlike simple snoring, obstructive sleep apnea is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease, stroke and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.
Sleep Apnea in Children
OSA also affects large number of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils, and adenoid. A simple Tonsillectomy and adenoidectomy gives them one hundred percent result.
Obesity and OSA
Fifty percent of patients coming for treatment in my clinic are not obese patients, mostly youngsters. The number of patients asking for surgery in young age group is increasing these days, most of them, before marriage or immediately after marriage. There are social and marital discord in increasing numbers in youngsters, lack of libido, decreased testosterone level, and separate bedroom make life intolerable in these age group.
How many apneas in a night
Sleep apnea is generally defined as the presence of more than 30 apneas during a seven hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night with severe oxygen desaturation.
Whom to see for Medical opinion
If you exhibit several OSA symptoms, it’s important you visit your ENT and Maxillofacial Surgeon for a complete examination and an accurate diagnosis.
At your first visit, your doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. An interview with your bed partner or other household members about your sleeping and waking behavior may be in order.
Nasal Endoscopy and laryngoscopy must be done to assess the obstructive airway and other pathology if any.
Sleep lab study-Polysomonogram
If the doctor suspects a sleep disorder, you will be referred to a sleep clinic, which will monitor your nighttime sleep patterns through a special test called polysomnography-Sleep Study.
Polysomnography will require you to sleep at the lab overnight while a video camera monitors your sleep pattern and gathers data about the number and length of each breathing cessation or other problems that disturb your sleep. This gives lot of information about your condition. Number and type of apnea, hypopnea, AHI index, RDI and Oxygen saturation all gives valuable information regarding the severity of OSA.
CT/MRI image study
Must be done to asses the obstruction in the upper airway, retroplalatal airway, and if any cerebral atrophy, infarcts etc. PN ration is important before planning surgery.
Weight loss â€“If Obese
Change of sleeping position â€” because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.
Avoid alcohol, sedatives, antihistamines, sleeping pills which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.
Your doctor has other treatment options, including the following:
CPAP (Continuous Positive Airway Pressure) and BiPAP (Bi-Level) – A CPAP device used to be the only treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea. Through a specially fitted mask that fits over the patient’s nose, the C-PAP’s constant, prescribed flow of pressured air prevents the airway or throat from collapsing. In some cases a Bi-PAP device, which blows air at two different pressures, may be used.
While C-PAP and Bi-PAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it. If you stop using the C-PAP or Bi-PAP, your symptoms will return. Although C-PAP and Bi-PAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not discontinue their use without talking to your doctor.
The CPAP is not accepted these days by younger patients to lead the rest of their life dependant on this device.
In my opinion, it is only indicated in those where surgery cannot be performed, like old invalid patients.
Laser Surgery for OSA
Obstructive sleep apnea can be effectively treated by surgery. Surgical intervention may be a viable alternative for some OSA patients; however, it is important to keep in mind that no single surgical procedure is universally successful.
Laser-Assisted Uvuloplasty (LAUP) is simple surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This procedure is generally used to relieve snoring and can be performed by ENT surgeon under local or general anesthesia. LAPT-Laser assisted Partial Turbinectomy, Laser assisted Septal surgery, Nasal Polypectomy, Laser Tonsillectomy and laser removal of prominent lateral pharyngeal bands all help bypass the obstruction.
These above procedure combined gives 80-90% success rate in my patients.
Other major Surgeries for Sleep Apnea
The following surgical procedures are done as last resort in selected cases. Rarely preferred by any OSA patients.
Uvulopalatopharyngoplasty (UPPP) â€“ was done before the days of Laser, not anymore.
Hyoid Suspension – If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam’s apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat. The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.
Genioglossus Advancement (GGA) – GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon; thereby, reducing the degree of tongue displacement into the throat.
Mandibular Advancement (MMA) – MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway.
OSA and Snoring are to be taken seriously in early stage. Get help. Get treated. It is matter of life and death.
For Appointment- call 0471-2334561/62/63/64, 6452020,407822 Fax-0471-2330925
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