Snoring and Sleep Apnea
Childhood Sleep Apnea
Pediatric Obstructive Sleep Apnea
Sleep disordered breathing (SDB) is a common problem for adults leading to hypertension, heart attack, stroke, and early death. Other consequences are bedroom disharmony, excessive daytime sleepiness, and weight gain, poor performance at work, failing personal relationships, and increased risk for accidents, including motor vehicle accidents.
Sleep disordered breathing in children, from infancy through puberty, is in some ways a similar condition but has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition as an adult.
Adult Sleep Apnea
Treatment of Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) is a common disorder involving collapse of the upper airway during sleep. This repetitive collapse results in sleep fragmentation, hypoxemia, hypercapnia, increased sympathetic activity. As specialists in upper airway anatomy, physiology and surgery, Otolaryngologists are uniquely qualified to treat patients with OSA. In the Clinical Guidelines for Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults, it is recommended that evaluation for primary surgical treatment be considered in select patients who have severe obstructing anatomy that is surgically correctible (e.g., tonsillar hypertrophy obstructing the pharyngeal airway) and in patients in whom continuous positive airway pressure (CPAP) therapy is inadequate. (Epstein, EJ, Evidence Based Clinical Guideline)
Forty-five percent of normal adults snore at least occasionally and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight people and usually worsens with age. Snoring may be an indication of obstructed breathing and should not be taken lightly. An otolaryngologist can help you to determine where the anatomic source of your snoring may be, and offer solutions for this noisy and often embarrassing behavior.
Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered the most effective nonsurgical treatment for the alleviation of snoring and obstructive sleep apnea.
If your otolaryngologist determines that the CPAP treatment is right for you, you will be required to wear the nasal mask every night. During this treatment, you may have to undertake a significant change in lifestyle. That change could consist of losing weight, quitting smoking, or adopting a new exercise regimen.
The Pillar Procedure is a minimally invasive treatment for snoring and obstructive sleep apnea. This procedure was FDA indicated in 2004. During this procedure, three to six+ dacron (the material used in permanent sutures) strips are inserted into the soft palate, using a modified syringe and local anesthetic. While the procedure was initially approved for the insertion of three “pillars” into the soft palate, it was found that there was a significant dosage response to more pillars, with appropriate candidates.
After this brief and virtually painless outpatient operation, which usually lasts no more than 30 minutes, the soft palate is more rigid and snoring and sleep apnea can be reduced. This procedure addresses one of the most common causes of snoring and sleep apnea – vibration or collapse of the soft palate (the soft part of the roof of the mouth). If there are other factors contributing to snoring or sleep apnea, such as the nasal airway or an enlarged tongue, it will likely need to be combined with other treatments to be more effective.
Sleep studies are tests that watch what happens to your body during sleep. The studies are done to find out what is causing your sleep problems. Sleep problems include:
- Sleep apnea, when an adult regularly stops breathing during sleep for 10 seconds or longer. This may be caused by blocked airflow during sleep, such as from narrowed airways. Or it may be caused by a problem with how the brain signals the breathing muscles to work.
- Problems staying awake, such as narcolepsy.
- Problems with nighttime behaviors, such as sleepwalking, night terrors, snoring.
- Conditions such as periodic limb movement disorder, which is repeated muscle twitching of the legs or arms during sleep.
Inspire therapy is a promising new FDA-approved treatment for people with moderate to severe Obstructive Sleep Apnea (OSA) who are not receiving consistent benefits from continuous positive airway pressure (CPAP).
- Inspire therapy is a fully implanted system that delivers mild stimulation to keep a patient’s airway open during sleep.
- Inspire therapy does not require a mask.
- Results from the STAR clinical trial, recently published in the New England Journal of Medicine, showed that Inspire therapy can significantly reduce sleep apnea events and significantly improve patient quality of life measures.