Obstructive Sleep Apnea | Sleep Apnea Surgery San Antonio
Welcome to Texas Center for Facial Plastic and Laser Surgery in San Antonio and the Obstructive Sleep Apnea Blog. A common question that I’m asked in San Antonio is how can airway obstruction be directly measured during natural sleep in patients with possible sleep apnea. First let’s discuss what defines airway obstruction during sleep.
Palate and Tongue Base Obstruction comprise the main obstructive sights in obstructive sleep apnea. Other causes of obstructive sleep apnea include the tonsils, lateral pharyngeal walls, epiglottis, and lingual tonsils. In children, the adenoid and tonsil tissue largely contribute to obstructive sleep apnea.
What is sleep disordered breathing?
Sleep disordered breathing (SDB) is a spectrum of syndromes comprised by snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea (OSA). A common sleep disorder, obstructive sleep apnea (OSA) incidence has been reported as 24% in males and 9% in females by attended polysomnogram in 602 undiagnosed state employees. Most patients fail to be diagnosed; in fact, 93% of females and 82% of males with moderate to severe obstructive sleep apnea have not been identified. The profound effects of SDB upon the cardiovascular and respiratory systems, and neuro-cognitive function have been documented. The Sleep Heart Health Study and the Wisconsin Sleep Cohort have demonstrated a strong association between SDB and hypertension. Patient with an apnea-hypopnea index (AHI) > 15 have a 2.89 fold greater chance of developing hypertension. In patients with an AHI > 11, 2.38 relative risk for congestive heart failure and a 1.58 risk for cerebrovascular disease exists.
How can natural sleep be measured?
Natural sleep is defined as a measure of the sleep state unimpeded by the measurement process. The gold-standard for diagnosing OSA is the attended overnight polysomnogram (sleep study) under as natural conditions as possible. Other measures including Drug Induced Sleep Endoscopy (DISE) require less than natural conditions under sleep including sedation, endoscopic instruments, and an artificial surgical environment. Paucity exists in a complementary study to indicate the cause of obstruction anatomically, and direct surgical therapy as to which is the best method and likelihood of cure. The perfect study would simulate natural sleep and distinguish normal non-snoring from snoring patients, and define OSA and its characteristic anatomic presentation. Many diagnostic studies have been utilized in diagnosis with shortcomings in its predictability to make diagnostic measures, direct corrective intervention, and predict outcome. Dr. Barrera employs several technologies to assess airway obstruction and the site of obstruction including our clinical head and neck examination, cephalometric x-ray data, flexible pharyngoscopy and laryngoscopy in the office, and Drug Induced Sleep Endoscopy (DISE).
What is Sleep MRI?
In regards to MRI during sleep, Dr. Barrera has published numerous studies on the use of Sleep MRI to determine (1) the characteristics of obstruction during the natural sleep state; (2) distinguish normal non-snorers from snoring patients; (3) determine the site of obstruction associated with upper airway resistance syndrome (UARS) from obstructive sleep apnea (OSA); (4) establish a clinical relevant tongue base staging system; (5) validate clinical tools currently available to otolaryngologists in diagnosing sleep disordered breathing. We have combined a portable sleep testing device, the Watch-Pat 100 with an Open MRI scanner to identify airway events in naturally sleeping patients. Sleep MRI is still experimental but offers a promising tool to identify the site of airway obstruction in OSA patients.
• Barrera JE, Holbrook AB, Santos JM, Popelka GR. Novel Quantification of Airway Obstruction in Adult Obstructive Sleep Apnea. CHEST Supplement, 132:464S, 2007.
• Holbrook AB, Barrera JE, Santos JM, Butts-Pauly K, Popelka GR. Real Time Sleep MRI and Physiologic Monitoring of Patients with Obstructive Sleep Apnea. ISMRM (International Society for Magnetic Resonance in Medicine), 2008.
• Barrera JE, Holbrook AB, Santos JM, Popelka GR. Characterization of Airway Obstruction and Autonomic System in Obstructive Sleep Apnea Syndrome. Proceedings of the Triological Society, 2008.
• Barrera JE, Holbrook AB, Santos JM, Popelka GR. Pulse Arterial Tone and Airway Obstruction in Sleep Apnea. Otolaryngology-Head and Neck Surgery, 2008.
• Recipient, Young Investigator Award at CHEST 2007 National meeting presented to Dr. Jose Barrera, MD.
• Presentation, Chest 2007 National Meeting “Novel quantification of airway obstruction in adult obstructive sleep apnea”, October 23, 2007
• Inventors: Barrera JE, Holbrook AB, Santos JM, Popelka GR.
• Patent: Pulse Arterial Tone as Leading Indicator for Airway Events in Obstructive Sleep Apnea, 2008. U.S. Patent Application No. 12/322,336
• Barrera JE, Holbrook A, Santos JM, Popelka J. “Sleep MRI: Novel Quantification of Airway Obstruction in Obstructive Sleep Apnea.” Otolaryngology-Head and Neck Surgery, 140:423-425, 2009.
• Barrera JE, Chang, RC, Holbrook A, Popelka GR. “Reliability of Airway Obstruction Analyses from Sleep MRI Sequences.” Otolaryngology-Head and Neck Surgery, 142:526-530, 2010.
• Triologic Society Thesis
Barrera, JE. Sleep MRI: Dynamic Characteristics of the Airway During Sleep in Obstructive Sleep Apnea Syndrome, Laryngoscope, Jun;121(6):1327-35 2011.