Monday, 16 January 2012

SNORING AND OBSTRUCTIVE SLEEP APNEA



Snoring occurs due to narrowing of the airway causing vibration of the soft tissues of the throat during sleep. It is more common in men generally whereby 45% of men and 30% of women snore on a regular basis.

Risk factors for snoring include overweight, increasing age, nasal blockage, sedating medications, alcohol, sleeping position and thick neck. It is important to recognize if snoring is related to an underlying medical problem such as obstructive sleep apnea (OSA) or is an isolated problem


What is obstructive sleep apnea (OSA)?
It is a severe form of snoring which has serious health consequences. OSA occurs due to complete collapse or obstruction of the upper airway, at one or a combination of these levels:

  • Nasal Airway  
  • Soft Palate/Tonsils
  •  Tongue Base 
  • Pharyngeal Walls




Symptoms of OSA
  • Loud, irregular snoring
  • Daytime tiredness and sleepiness
  • Early morning headaches
  • Poor concentration
  • Deterioration of intellectual capabilities
  • Mood swings

Diagnosis of OSA

A complete ear, nose and throat examination by endoscopy is performed in the clinic to assess the possible sites of airway obstruction during sleep. The body mass index is measured.

Sleep study is often recommended to confirm and determine severity of OSA
OSA severity is indicated by the Apnea / Hypopnea Index (AHI)
· Mild: 5 – 15 events / hour
· Moderate: 16 – 30 events / hour
· Severe: > 30 events / hour
(events is when there is almost or total obstruction of the airway causing a drop in oxygen blood saturation)
Consequences of OSA
It is very important to recognize and treat OSA because if left untreated it can lead to serious health consequences:
Hypertension
Myocardial infarction
Stroke
Type II diabetes
Depression
Cognitive dysfunction
Impotence, sexual dysfunction, or reduced libido
Morning headaches
General preventive measures for snoring
§ Sleep hygiene
     - Regular sleep-wake times
     - Peaceful surroundings
     - Moderate room temperature
     - Avoidance of night shift and changing work shifts
§ Reduction of weight
§ Exercise
§ Avoid alcohol and sedatives before bedtime


Treatment options for OSA



APAP (Automated Positive Airway Pressure) with Mask
It is the Gold Standard treatment for Sleep Apnea. Patients are required to wear a face or nasal mask which blows in humidified air. This will help to ‘splint’ the airway open during sleep.

Oral appliance
Oral Appliance Therapy is a suitable front-line treatment option for mild to moderate OSA sufferers and simple snorers. The Oral Appliance is worn during sleep to maintain the patency of the upper airway.


Surgical treatment options for OSASurgery is aimed to relieve the obstruction. Therefore the type(s) of surgery recommended varies between patients.

The surgeries that can be performed include
· Tonsillectomy and adenoidectomy
· Septoplasty and turbinate surgery
· Soft palate surgery
· Base of tongue surgery
· Surgery to facial bones in selected cases

OSA in children 
The symptoms may differ from adults as children with OSA can present with mouth breathing, behavioural problems/ irritability, learning difficulties, hyperactivity and bedwetting. Often these children have large tonsils and adenoids which cause the airway obstruction and snoring. Obesity is a less common reason for OSA in children.

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