The most common sleep disturbances originate in the head and neck.  This uniquely qualifies the Otolaryngologist to diagnose and manage airway-related sleep problems known as obstructive sleep apnea (OSA).  Apnea means “to stop breathing.” OSA describes a condition where breathing stops during sleep. Short term consequences, may include headache, poor job performance, and reduced capacity to perform daily tasks such as driving a car, or remaining attentive during business meetings.  It can also aggravate serious health conditions including cardiovascular disease, depression, hypertension and irregular heart beat.

Both snoring and OSA are caused by restrictive air movement in the upper airway.   This may include restriction at the level of the nasal passages or the lower air transpot pathways.  Restrictive air movement favors airway collapse.  Complete airway collapse triggers a brain feedback mechanism that breaks the sleep cycle.  This forces the individual to wake up in order to prevent persistent lack of oxygen flow to the brain.  By contrast, snoring results from partial airway collapse in which case turbulent air flow and surface collisions within the airway give rise to noisey breathing or snoring.  This is a common condition that affects 40% of men and 20% of women.

Non-Surgical Treatment Options

  • Weight loss
  • Smoking cessation
  • Reducing bed time alcohol consumption
  • Treatment of nasal allergy with medication
  •   CPAP includes an air pump which is worn over the face.  It increases the pressure in the airway, forcing it  to   remain open during sleep.  Though non-invasive and conceptually simple, this treatment modality is not always successful.  The literature suggests that CPAP failure is common in individuals who have trouble breathing freely through their nasal passages

Surgical Treatment Options

Procedures are tailored to remodel the upper airway structural components that are responsible for causing airway obstruction during sleep. Sentinel to diagnosis is fiberoptic nasopharyngeal endoscopy which helps with determining the site of obstruction.  Abnormalities in the the following sites are visualized carefully for corect diagnosis:  nasal passages, soft palate and uvular complex, tonsils, adenoidal pad, base of tongue, and lower airway to the level of the voice box.  Based on the site obstruction and the sleep study findings, an individualized surgical scheme is then proposed. This proposal includes a number of procedures that are most commonly performed at one operative setting, though in a small number of cases they may be staged over time.  The procedures include:

  • Uvulopalatopharyngoplasty (UPPP) - Involves trimming and resuspension of the soft palate and the uvular complex in order to prevent collpase of the more uppermost aspects of the entry gateway into the airway.
  • Tonsillectomy and Adenoidectomy (T&A) - The most common treatment in children and young adults.
  • Coblation® of the Tongue Base - Uses radiofrequency to reduce the volume of excess tissue.
  •  Nasal Surgery  -  This may include straightening a deviated septum, reducing the turbinate size, or removing nasal polyps.
  • Somnoplasty - Employs radiofrequency to reinforce and strengthen a floppy soft palate.

 

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