Causes of SNoring and sleep apnea
In adults, the blockage may be from problems of deviated nose septum, large inferior turbinates, redundant/ low lying soft palate and medialized posterior tonsil pillars, poor pharyngeal tone, obesity, tongue base collapse/ hypertrophy, laryngeal collapse and mandibular retrognathia. More rarely from central brain pathology. (Read More: Snoring Across The Ages) (Read More: DxD Sessions – FAQ on Sleep Apnea)
Thirty percent of the world’s adults are snoring regularly. Snoring may disturb your partner but without health concerns, as in simple snoring. However, it needs to be evaluated to exclude central or obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) – OSA and UARS are associated with blood oxygen deprivation and increased work of breathing leading to disturbed sleep and daytime sleepiness. Long term, oxygen deprivation increases the risks of heart attacks, hypertension, diabetes, stroke and memory problems by 3 to 5 times. Of women with preeclampsia blood pressure problems in pregnancy, 50% have OSA.
Adults complain of daytime sleepiness, irritability, depression, impaired concentration/ memory, fatigue and morning headaches. At night, there is choking or stopping of breathing episodes, grinding of teeth, increased urination and poor libido.
Investigations offered for snoring and sleep apne
- General examination of weight, ear, nose, throat, facial and neck structures
- Flexible nasolaryngoendoscopy in clinic to determine the sites, cause and severity of obstruction
- Sleep endoscopy under general anaesthesia if needed
- Sleep study (home or hospital based) to determine the severity and pattern of apnea
Treatment offered for snoring and sleep apnea
- Non-surgical treatment to improve on obesity, allergic rhinitis and sleep habits/ position. Reduce alcohol intake.
- Referral to respiratory/ neurology colleagues for central apnea
- Continuous positive airway pressure mask (CPAP) is highly effective for OSA. These are increasingly portable and comfortable. A good mask fit .is key, and correct use of and maintenance of the mask and a clear nasal airway is important.
- Work with oral-maxillofacial dentists for oral appliances worn during sleep to advance the jaw and tongue
- First- line surgery addresses the nose, soft palate and tonsil sites of block. In some patients, this is helpful even if CPAP masks are worn, to decrease airway resistance and discomfort during use of the mask.
- Second-line surgery addresses the base of tongue and larynx sites of block
- Simple surgeries like radiofrequency reduction of the inferior turbinates and elevation of the soft palate are possible in clinic, but more invasive surgeries like more extensive uvulopharyngopalatoplasty, base of tongue reduction would require general anaesthesia
- Third- line surgery by oral-maxillofacial specialist addresses the tongue base and advances the mandible lower jaw. Done together with dental realignment.
- Bariatric surgery by general surgeons by in cases of severe obesity that has failed lifestyle modifications and exclusion of hormonal factors.