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Snoring and Sleep Apnea

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SleepDisordersSnoring and Obstructive Sleep Apnea are separate but sometimes associated disorders that result from upper airway obstruction.  Snoring results from multiple factors that may include nasal airway obstruction, obesity, mouth breathing, enlargement of the adenoid, tonsils, and base of the tongue, and vibration of structures such as the uvula and soft palate. Obstructive Sleep Apnea (OSA), or cessation of breathing during sleep, may result from the same factors, but is a more serious health condition.  Medical studies have shown that OSA increases overall mortality rates.  OSA interrupts the normal pattern of sleep which causes tiredness and immediately increases the risk of having an accident while driving or operating machinery.  Additionally, OSA (over time) places stress on the body created by low oxygen levels, and magnifies the risk of developing high blood pressure, heart attack, and stroke.  Signs of OSA include daytime fatigue, morning headache, and not feeling rested even after an adequate time period of sleep.  An overnight sleep study (polysomnogram) helps to distinguish between the two conditions.  During a sleep study, measurements are taken of your heart rate and rhythm, blood oxygen levels, brain waves, muscle movements and breathing patterns.    

Medical (non invasive) treatments for snoring and OSA

Medical treatments that may alleviate snoring and OSA include losing weight, avoiding alcohol, caffeine, sedatives and heavy meals near bedtime, and changing your sleeping position as you tend to snore more when sleeping on your back than when sleeping on your side.   Additional medical treatments for OSA include oral dental appliances and CPAP.  CPAP (Continuous Positive Airway Pressure) is delivered by a machine that uses air pressure to prevent the tissues in your throat from collapsing while you sleep.  The air is blown through a mask fitted over your nose (and sometimes your mouth) that is worn while sleeping.  CPAP needs to be worn all night, every night, in order to be effective, or else the symptoms and harmful medical effects of OSA will return immediately. If used properly, CPAP resolves OSA in nearly 100% of patients.

Multilevel surgical treatments for snoring and OSA

snoreSurgery is considered for snoring when the effects of the noise become too intrusive.  Surgical intervention for OSA is considered when weight loss has failed and the patient cannot tolerate or chooses not to wear CPAP.   

Surgery to treat snoring and OSA is designed to reduce obstruction or narrowing in the anatomic areas that cause the medical problem.  Frequently, there is more than one anatomical area involved and a multilevel surgical approach is used to correct all of the causes of snoring and OSA, which include the nasal passages, palate and uvula, tonsils and adenoids, and tongue.

Nasal surgery for snoring and OSA

Nasal surgery to treat snoring is generally focused on improving a narrow nasal passage.   A nasal passageway can be obstructed by swelling of the turbinates, septal deviation and nasal polyps. Surgery to address each of these potential causes of obstruction can improve the flow of air through the nasal passages.

Palate surgery for snoring and OSA

The soft palate is the flap of tissue that hangs down in the back of the mouth. If it is too long or floppy, it can vibrate and cause snoring. The uvula is suspended from the center of the palate. An abnormally long or thick uvula can also contribute to snoring.  The most commonly performed surgery for treatment of snoring and OSA is the UvuloPalatoPharyngoPlasty (UPPP).  This procedure removes the uvula, trims the redundant tissue of the soft palate and widens the air passage at the back of the throat.  If enlarged tonsils and/or adenoids are present, they are also removed as part of the procedure.

Other procedures, such as an injection snoreplasty, radio frequency palate ablation and a pillar implant all work to stiffen the tissues of the palate.  After each of these procedures, the tissue heals as scar tissue, and the palate becomes stiffer and vibrates less.

Base of Tongue Surgery

Reducing the muscle bulk at the back of the tongue is utilized in cases of severe OSA.  An oversized tongue contributes to the blockage of airflow during sleep.  Reducing the size of the tongue may be achieved with the removal of the tongue muscle.  A newer procedure called an ablation uses radio frequency technology to shrink the tongue base resulting in less pain and postoperative swelling.

Success of Surgery

Surgery is generally successful in reducing snoring and OSA. The success of a procedure depends on the problem area causing the snoring. For example, someone with nasal congestion will not have much improvement with a palate procedure and vice versa. The other factor that makes success hard to measure is the definition of success. As discussed earlier, the goal of surgery is a successful night’s sleep for those around the snorer.

Generally, scar tissue in the palate continues to form for up to three months.  Up to 77% of people report reduced snoring after this procedure, however, as the tissue continues to heal over time, the palate may soften and re-obstruct.  One study demonstrated a 29% relapse in snoring after one year.  Similarly, palate implant surgery was recommended by 89% of snorers, but only 69% of their partners.  Only the snorer’s partner will determine if the improvement in snoring is a “success.”   UPPP is successful in stopping snoring in 90% to 95% of patients.  When combined with tongue reduction surgery, studies show OSA is greatly improved or resolved in 80% to 85% of patients.

Subjectively, the vast majority of patients experience relief of their symptoms and thereby gain more energy, improved memory and concentration, and finally enjoy the feeling of a “good night’s sleep.”