Obstructive Sleep Apnea
Apnea means “lack of breath”. Pauses or cessation of breathing while sleeping has many long term affects and can be quite dangerous. It is an insidious problem that sneaks up people. There are basically 3 types of sleep apnea: Obstructive, Central and Mixed. The most common is the obstructive form and usually associated with weight gain, anatomic variations, sedative use and some sleep positions. Left untreated, this disease can have many side effects and can be lethal. Most patients with this problem describe poor quality sleep and excessive daytime drowsiness and snore incessantly. Anatomic variations that predispose to this condition include a narrow throat inlet due to excessive soft tissue and redundancy, large tonsils/adenoids, small jaw, large tongue base, tumors, nasal obstruction and other congenital causes. The diagnosis can be determined and quantified with a sleep study test that measures the number of times/hr (apnea index) one stops breathing, oxygen levels, sleep efficiency and many other important parameters that may help determine a treatment plan as well as a few hours of sleep with a CPAP machine if needed. Though not fun, the CPAP machine is indeed therapeutic for many patients, but the compliance rate is low. CPAP machines take some time to get used to and find the best settings. There are also a wide variety of masks, and it may take some time to find the best one with the best fit. When a patient cannot tolerate a CPAP machine for various reasons, then one may look at surgical options as well as medical management, i.e. weight loss.
The surgical management of OSA (Obstructive Sleep Apnea) is designed to open the oral and/or nasal airway. With a thorough exam, and after a sleep study is performed, surgery may be considered as an option. The standard operation is known as UPP (Uvulopalatopharyngoplasty), which removes the uvula, some of the soft palate and/or tonsil tissue. This procedure is not 100% effective, but can reduce a patient’s apnea index by 60-70% and reduce snoriing but requires a stay overnight in the hospital and about 10-12 days to recover. Other procedures include, Somnus Radiofrequency Base of Tongue Reduction, which involves placing a radiofrequency probe into the base of the tongue muscle at several sites, under general anesthesia and causing some scarring deep in the muscle to shrink it down and firm it up. This operation takes a few minutes under general anesthesia and is also effective at reducing the apnea index. If a patient has a small or recessed lower jaw, correcting this may bring the tongue forward and prevent its collapse into the airway. There are other operations that bring the tongue muscles forward (genio-hyoid advancement) thay may also help. It is easy to see that OSA is a complicated disease with many modalities to treat it. A comprehensive plan is imperative to treating OSA before it becomes life threatening.