Snoring and Sleep Apnea
Does your spouse or bed partner keep you up at night with snoring and sleep apnea San Antonio?
Snoring and sleep apnea can be diagnosed and treated with sleep endoscopy and surgery targeting the site of airway obstruction.
Snoring and Sleep Apnea Surgery helps to correct nasal and airway obstruction. Causes of obstruction include nasal deviations or narrowing, soft palate redundancy, a large tongue, or a small airway.
WHAT IS OBSTRUCTIVE SLEEP APNEA?
Snoring and sleep apnea are part of a spectrum of syndromes called sleep disordered breathing. This syndrome is comprised of snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea (OSA). OSA is a syndrome not a disease and the specific etiology is unknown. However, it is largely secondary to anatomic upper airway narrowing during sleep and a yet unidentified central nervous system (CNS) component. Obstructive sleep apnea syndrome consists of periods of apneas (cessation of airflow at the nose or mouth for > 10 seconds) and hypopneas (reduced respiration with desaturation terminated by arousal). In general, OSA can be defined by the number of apneas and hypopneas per hour or apnea-hypopnea index (AHI). Mild OSA is defined as an AHI > 5 and < 15 but with symptoms of sleepiness. Moderate OSA is an AHI > 15, < 30 and severe OSA is an AHI > 30. The prevalence of OSA was reported in an epidemiologic study to be 24% in males and 9% in females by attended polysomogram. Most patients fail to be diagnosed; in fact, 93% of females and 82% of males with moderate to severe OSA have not been identified.
The profound effects of SDB upon the cardiovascular, 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. Other risk factors associated with SDB include heart failure, stroke, motor vehicle accidents, excessive daytime sleepiness, depression and obesity.
HOW DO WE EVALUATE PATIENTS?
A complete history should be taken from the patient. It can be broken into behavioral quality of life issues and physiologic derangement. Patients with OSA suffer from quality of life issues including nighttime complaints of snoring, unusual movement, insomnia, hypersomnia, and sexual dysfunction. In addition, daytime dysfunction including sleepiness, morning headache, learning and memory problems, and depression are common.
Patients with OSA most often complain of excessive daytime sleepiness (EDS). The patients may experience serious social, economic, and emotional problems from
the EDS associated with this syndrome. The uncontrollable desire to sleep may predispose the patients to safety sensitive occupational or automobile accidents.
IS SNORING AN INDICATION OF A SERIOUS PROBLEM?
Almost all patients or their bed partners give a chronic history of heavy, loud snoring. The snoring is produced from the passage of air through the oropharynx causing vibrations of the soft palate. Typically the snoring is interrupted by periodic apneic episodes that may last 30 to 90 seconds. A loud snort followed by a hyperventilation usually signals an end to the apneic episode.
WHAT ARE MORNING HEADACHES AN INDICATION OF?
Morning headaches and nausea result from unexpelled carbon dioxide (hypercarbia) which develops obstructive episodes during snoring and sleep apnea.
DID YOU KNOW THAT YOU CAN DEVELOP HIGH BLOOD PRESSURE AND CARDIAC PROBLEMS FROM SLEEP APNEA?
Pathophysiologic abnormalities include systemic hypertension that is a common finding in OSA and may be related to abnormal sympathetic tone during sleep. In more severe cases, pulmonary hypertension, polycythemia, and cor pulmonale may develop and become life threatening.
Sinus dysrhythmia is commonly associated with the apneic episodes. Bradycardia may be directly proportional to the severity of oxygen desaturation. The development of severe and life-threatening medical complications from the apneic events clearly depends on the frequency, duration, and degree of hypoxemia and associated hypertensive response.
These procedures require a sleep study for evaluation and an evaluation of the airway in clinic.
A contemporary two-phase surgical approach for OSAS treatment has been developed to limit over operating and to decrease risks of surgery. It is important to note that if this phased protocol is used the patient and referring physician must understand that both phases may be necessary. The protocol was not intended to be a single phase protocol. A polysomnogram is necessary after phase one (3-6 months). If the patient is controlled no further treatment is needed. If incompletely treated then phase two is appropriate.
The first phase is the most conservative approach and addresses palatal and tongue base obstruction without movement of the jaw or teeth. Learn more at Sleep Surgery at Texas Facial Plastic Surgery and ENT. It should be emphasized that improved surgical success is dependent upon optimizing the soft-tissue or primarily phase I protocol prior to beginning phase II.
Patients who have had incomplete response or failed to respond to phase I intervention may be considered for a phase II operation or maxillomandibular advancement (MMA). The MMA advances the midface and provides more room for the tongue. Additionally, the saggital split osteotomy of the mandible places additional tension on the tongue-hyoid complex.
Combined advancement of the maxilla and mandible is the most recent and efficacious surgical procedure for the treatment of obstructive sleep apnea. The surgical technique includes a standard Le Fort I osteotomy in combination with a mandibular sagittal split osteotomy. A concomitant Genioglossus advancement as previously described, is an adjunct and recommended to improve tongue advancement. MMA surgery may result in some facial change, which is most often favorable. However, the patient must be made aware of the possibility of any unfavorable aesthetic outcomes that may occur from this surgical procedure.
Nasal Reconstruction or Functional Rhinoplasty
Palate surgery (UPPP or uvulopalatal flap)
Genioglossus advancement (GTA)
Tongue base radiofrequency
Re-Evaluate at 4 to 6 Months
For incomplete treatment of phase one
Maxillomandibular Advancement (MMA) or