Overview

Overview Obstructive Sleep Apnea

Click here to go to the snoring/obstructive sleep apnea questionnaire.

Occurrence of OSAS

q There is a continuum between a wide-open upper airway and a completely collapsed one—from simple snoring to UARS to severe OSAS.

q Obstructive sleep apnea is much more common than previously realized—about as common as asthma.

q Nevertheless, OSAS has traditionally been under-recognized by the medical community. Through a concerted campaign by sleep professionals, more and more physicians and lay people now realize how common and potentially dangerous OSAS is.

OSAS Morbidity

q OSAS carries a risk of substantial morbidity and mortality:

q Cardiovascular disease

q Hypertension

q Excessive daytime sleepiness (EDS) and its consequences

q Heavy snorers with EDS or witnessed apneas warrant evaluation by sleep study.

Snoring Surgery

q Snoring may be successfully treated by a variety of surgical modalities, generally concentrated on the palate.

q Somnoplasty™, UPF, and LAUP are good alternatives to UPPP for snoring or mild to moderate apnea due to palatal obstruction. Somnoplasty™ appears the most promising as it has essentially no morbidity and is almost completely painless.

CPAP for OSAS

q CPAP when used every night controls OSAS.

q Objective measures of analysis suggest approximately 50% long-term compliance with CPAP.

q If CPAP noncompliance is not recognized, about half of these patients are not adequately treated.

Surgery for OSAS

q Surgery for OSAS should be offered to those who cannot tolerate CPAP or who have obvious anatomical abnormalities.

q Thorough surgical treatment results in efficacy equal to nasal CPAP, with cure rates up to 90% or more.

q A successful result depends on the recognition of the potential for multiple levels of airway obstruction.

q Most patients with significant OSAS require treatment of both the palate and the tongue base.

q The tongue base can be treated either by advancing it forward or by removing excessive tissue. The decision as to how best to proceed is made based on the patient’s anatomy, expectations, etc.

q It is essential to obtain objective measurement of efficacy of any treatment modality with sleep study data.

q Comprehensive surgical treatment of OSAS is only available in a small number of centers around the country, and requires specialized training in the pathophysiology of OSA, difficult airway management, soft tissue techniques, and skeletal surgery.