Jubilee Hospital, Trivadrum.
Obstructive sleep apnea (OSA) syndrome is a potentially serious disorder affecting a lot of people. Many of these individuals are undiagnosed as there is a lack of awareness of this complex syndrome.
With obstructive sleep apnea (OSA), there are blockages in the upper airway and cause breathing to stop for at least ten seconds or more. These apnea episodes last sometimes several hundred times and AHI index rises to very high level. There is loud snoring associated with OSA.Often there is oxygen desaturation going to a dangerous levels. The patients are of all age groups, mainly young adults in their 20s and 30s.Obesity is not a common factor. It seems run in families.
Apart from social problems, there are lots of medical issues more serious in nature associated with it. Heart problems, High BP and stroke are commonly seen in chronic OSA patients.
I have been treating OSA patients since 1996.Several hundred or may be a thousand plus patients had been treated and cured.
Patient work up
After taking a full history from patients and their spouse or relative, a thorough physical examination of the upper airway is done to find out the areas of airway obstruction.
A nasophayngo laryngoscopy is performed in the clinic. CT or MRI Imaging of the upper airway and brain is also done.A narrow retropalatal airway is common finding in the CT /MRI imaging.
Routine blood tests, X-ray chest ECG and a pre anesthetic/ cardiac check up are done.
Sleep study is attempted if possible. But not always possible. It is better to have a PSG done prior treatment.
Conservative treatment- medical and loosing weight, if obese, avoiding alcohols, sedatives, are tried at first.
CPAP is not advised in those who are fit for surgery . It is indicated in very old and inoperable cases only. Most patient who buy the machine are unhappy and don\’t use it at all. More over the principle of treatment of OSA is by removing the “obstruction” not bypassing it.
The surgical treatment aims at removing obstruction at various level. Accordingly a variety of procedure had to be done-
1. Septopladty
2. Turbinate reduction
3. Nasal polypectomy
4. Adenoidectomy
5-Tonsillectomy
6-LAUP
7. Removal of lateral pharyngeal bands
8-Reduction base of tongue
9-Mandibular ostetomies
10-Hyoid suspension
11-Tracheostomy as the last resort.
LAUP, LAPT, LAS, LAT
The intention of laser surgery is to open the airway sufficiently to eliminate or to reduce obstructions to a clinically insignificant level. In order to does so, surgical therapy in adults often must remove the soft tissues of nose, nasaopharynx and oropharynx-such as the uvula, the soft palate, and tonsils.
Uvulopalatopharyngoplasty (UPPP) was done in olden days but not anymore, a more recent surgery using a laser (laser-assisted uvulopalatoplasty or LAUP, a modification of the UPPP where the surgeon cuts the uvula with a laser) is performed for snoring and OSA.
Laser surgery for OSA is very effective giving an overall success rate of 80-90% in my patients over a period of 15 years.
Appointment
Clinic hours: 8AM -1 PM Mon-Wed-Friday
Operation : 8AM-4PM -Tue-Thu-and Saturdays
For Appointment- call 0471-2334561/62/63/64, 6452020,407822 Fax-0471-2330925
Email: drpaulose@yahoo.com
