Snoring and sleep apnea

LEARNING OBJECTIVES:

Sleep-Disordered Breathing
Definition
sleep-related breathing abnormalities ranging from snoring to obstructive sleep apnea (OSA)
Apnea: drop in oronasal thermal sensor ≥90% of baseline lasting
≥10 seconds
Central Apnea: apneas without associated respiratory effort
Obstructive Apnea: apneic event associated with increase in respiratory effort throughout event

Obstructive Sleep Apnea Syndrome (OSAS)
Life threatening condition.
Introduction
Diagnostic Criteria ≥5 respiratory events (apnea or hypopnea)/hour with respiratory effort with symptoms (e.g., daytime somnolence, snoring, fatigue, insomnia, witnessed apneic events) or ≥15 respiratory events/hour with respiratory effort without symptoms

Etiology
due to a combination of anatomic and neuromuscular factors:
1. Adeno-tonsillar hypertrophy
2. craniofacial abnormalities
3. neuromuscular hypotonia (i.e. cerebral palsy, Down syndrome)
4. obesity

Stroke: OSAS and snoring increases risk of stroke and stroke leads to OSAS
SSx: daytime somnolence, snoring, witnessed apneic events, morning headache (nocturnal CO2 retention), mouth breathing, weight gain, abnormal motor activity, bruxism, depression, irritability, insomnia, enuresis (children), sexual dysfunction.

Effects of untreated OSAS
Mortality: 2.5× risk of driving accident, 3–6× risk of sudden cardiac death at night, higher mortality from heart failure
Morbidity: 3× risk of hypertension, pulmonary hypertension stroke, insulin resistance, arrhythmias, ischemic heart disease
75–100% have gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) improves with CPAP)

Investigations
flexible nasopharyngoscopy for assessment of nasopharynx and adenoids intraoperative
Polysomnography (gold standar ) preoperativly

Medical Management of Obstructive Sleep Apnea
treat comprehensively, taking into consideration all therapeutic options
Behavior Modifications: weight loss, abstain from sedatives and alcohol, positional therapy, safety precautions (avoid driving, heights, machinery when tired)
CPAP best and effective treatment option
Mandibular Repositioning Device: indicated for snorers and mild to moderate OSAS

Mandibular Repositioning Device

CPAP

Surgical Management of Obstructive Sleep Apnea
Above Palate bone ( Rajab ) Nose surgeries &/or maxillary surgeries .

Surgical Management of Obstructive Sleep Apnea
Nasal Surgery/Reconstruction eg septoplasty
Nasopharyngeal Surgery eg Adenoidectomy
Oropharyngeal and Velopharyngeal Surgery eg Tonsillectomy
Palatoplasty ( LAUP. UVPP? )
Barbered suturing.
Hypopharyngeal Surgery eg lingual Tonsillectomy
Hyoid suspension, Implantable lingual nerve stimulator.
Mandibular and Midface Advancement Techniques
Tracheotomy