Snoring & Obstructive Sleep Apnea

What is Obstructive Sleep Apnea?

Occasional snoring can be a nuisance. Habitual snoring often strains relationships, causing frustration and fatigue in both the snorer and the bed partner. Snoring is noisy breathing resulting from upper airway structures intermittently coming in contact and temporarily obstructing airflow during inhalation. Snoring commonly results from decreased muscle tone in the throat during sleep which allows the soft palate, uvula, and back of the tongue to collapse onto the back or side walls of the throat. Several factors can make a person predisposed to snoring. They include nasal obstruction, large tonsils or adenoids, an elongated and thickened soft palate, a large uvula or tongue, excess tissue surrounding and narrowing the throat (obesity), throat or neck tumors and conditions which cause decreased muscle tone in the throat (alcohol, sedatives, extreme fatigue).

Snoring can indicate a more serious medical condition known as obstructive sleep apnea. Obstructive apnea occurs when the “flopping” of upper airway structures during snoring causes a temporary but complete cessation of airflow through the throat lasting 10 seconds or more. During the obstructive apnea, the patient’s abdomen rises as if he or she is trying to take a breath but no air is pulled into the lungs. During the apnea, the blood oxygen level can drop, decreasing the amount of oxygen supplying the brain. Blockage of airflow for less than 10 seconds is known as hypopnea and can be equally as dangerous. While the oxygen level drops, the body responds by interrupting sleep and subconsciously waking the patient up enough to open the throat and gasp for air. This results in non-rejuvenating sleep and daytime fatigue. Morning headaches, poor concentration, daytime sleepiness, dry throat and reduced productivity at work are all signs and symptoms consistent with sleep apnea. Over time, when left untreated, obstructive sleep apnea can result in hypertension and heart failure.

Habitual heavy snoring or snoring associated with daytime fatigue warrants a thorough evaluation by an Otolaryngologist. The breathing passages of the nose and throat should be carefully evaluated for structural causes of snoring and apnea. Nasopharyngoscopy (examination of the nasal cavites and throat with a fiberoptic telescope) is usually performed and most heavy snorers or those with significant daytime sleepiness are referred for a polysomnogram (sleep study). During the sleep study the patient spends the night in a laboratory where oxygen level, heart rate, muscle tone, brain waves (by stickers placed on the skin of the scalp) duration of sleep and number of apneas/hypopneas are recorded. The patient’s history, upper airway exam and sleep study help confirm a diagnosis of obstructive sleep apnea.

Medical and surgical treatments exist for both snoring and obstructive sleep apnea. The physical examination and sleep study results along with the patient’s desires help determine the appropriate therapy. Treatment options include:

Medical Treatment of Snoring and Sleep Apnea:

• Weight loss-diet and fitness regimen
   
• Alcohol and sedative avoidance
   
• Sleep position training
• Breathe Right Strips (when external nasal collapse is a contributing factor)
   
• Continuous Positive Airway Pressure (CPAP) machines
   
• Oral appliances and mouthpieces worn at night

Surgical Treatment of Snoring

• Uvulectomy (removing or trimming the uvula)
   
• Palatoplasty (trimming or reshaping and stiffening the soft palate)
   
• Uvulopalatopharyngoplasty (UPPP) (trimming the palate and tightening the sidewalls of the throat)
   
• Tonsillectomy (removing the tonsils)
   
• Transpalatal Advancement (trimming the bony palate and advancing the soft palate forward)
   
• Septoplasty (straightening an obstructing nasal septum)
   
• Inferior Turbinate Submucous Resection (removing portions of enlarged turbinate bones in the sidewall of the nose)
   
• Inferior turbinate reduction (reducing the size of the turbinate with surgery or radiofrequency energy)

Surgical Treatment of Obstructive Sleep Apnea

• Uvulectomy
   
• Palatoplasty
   
• Uvulopalatopharyngoplasty (UPPP)
   
• Tonsillectomy
   
• Transpalatal Advancement
   
• Genioglossus Advancement (advancing a portion of the jaw and tongue forward)
   
• Hyoid Suspension (tightening and stiffening the walls of the throat)
   
• Tongue Base Reduction (removing a portion of the enlarged back of the tongue)
   
• Tongue Base Suspension (moving the back of the tongue forward and suspending it)
   
• Septoplasty
   
• Inferior Turbinate Submucous Resection
   
• Inferior Turbinate Reduction
   
• Functional Rhinoplasty (using cartilage grafting to support the external sidewalls of the nose to keep them from collapsing)