A Family Doctor's Tale - SNORING

DOC I HAVE SNORING

Snoring is the symptom of spectrum of problems including Sleep disorders such as Obstructive Sleep Apnea during which breathing is interrupted during sleep.

About 24 per cent of the local population are loud habitual snorers.

Causes of snoring:
The cause of snoring is due to the vibration or flapping of the tissues lining the upper respratory passages.

Snoring in most people are due to multiple factors each playing some part in the snoring process:
1.Inadequate muscle tone of the palate, tongue and pharynx leads to airway collapse during inspiration causing the walls of the airway to vibrate.

2.bulky tissue in the upper respiratory airway(adenoids and tonsillar hypertrophy, cysts and tumors)cause narrowing of the airway and result in snoring.

3.excessive soft palatial tissue or long uvula can also vibrate during breathing causing snoring.

4.a backward prolapsing tongue may fall backwards into the throat when sleeping on the back and contribute to snoring

5.anatomical abnormalities in the nose(deviated nasal septum, hypertrophied inferior turbinates) or congested nasal passages (allergies, sinusitis, nasal polyps) can cause poor nasal inflow and make the soft tissues of the palate and throat vibrate.

Systemic disorders:
1.Hypothyroidism -large tongue

2.Acromegaly - large tongue

3.heartburn resulting in congestion of the throat

4.Obesity - enlarged tongue or uvula

Symptoms:

1.snoring present in 20% of men and 5% of women at age 30-35 years.
At age 60 years or more, 60% of men and 40% of women snore habitually

2.unrefreshed sleep

3.daytime sleepiness

4.poor concentration

5.forgetfulness

6.morning headaches

7.dryness of mouth in the morning

8.irritabilty

9.depression

10.sexual dysfunction

Signs:

1.Enlarged nasal turbinates, polyps , and nasal blockage

2.Enlarged tonsils and adenoids

3.Long uvula

4.large protruding tongue


Diagnosis of Snoring is made:
1.Symptoms of snoring, nasal congestion and inadequate sleep

2.observation of airway obstruction during sleep

3.Sleep study using monitoring devices such as

a. electroencephalogram(EEG)

b electro-oculogram(EOG)

4.Electrocardiogram(ECG)

5.Blood oxygen studies

6.Nasal and oral airflow

7.Thoracic and abdominal movement

8.Snoring sounds

Complications:
1.higher risk of hypertension

2.cardiovascular disease

3.Congestive heart failure

4.cardia arrhythmias

5.cerebrovascular accidents

Treatment:
A.Non Surgical treatment:

1.Continuous Positive Airway Pressure(CPAP)
CPAP administered by mask through the nose is the single most effective least invasive treatment for Obstructive Sleep Apnea.
It can improve all the bad effects of OSA.

2.Oral appliances which pushes the mandible forward and prevent it from falling open during sleep

3.Nasal Congestion treatment:
Patients with nasal congestion and blockage should be treated with antihistamine and decongestant

4. Weight reduction:
Any obese patients should have at least 10% of his weight reduced over a 6 months period

B.Surgical Treatments:
1.Surgery on the upper pharyngeal airway(uvula and palate)

a.Radiofrequency reduction of the palate and uvula shrinks the tissues of these and is indicated in simple snorer or mild OSA.

b.Uvulopalatopharyngoplasty (UPPP) surgery includes uvulectomy, palatal releasing and shortening incisions.

2.Surgery of the Tongue base:
Radiofrequency reduction is done for mild cases.
Advancement of the tongue, hyoid suspension is done under general anesthesia. All these enlarge the posterior airway space.

3.Maxillomandibular Advancement:
This is the most effective surgical procedure for treatment of OSA.It causes enlargement of the pharyngeal and hypopharyngeal airway by physically expanding the skeletal framework.

Prognosis depends on the severity of the condition but is generally good.

Prevention:
1.Lose weight in obese individual with snoring

2.Healthy lifestyle with balanced diet and exercise.

3.Neck elevation to prevent obstruction of airways and heartburn

4.Sleep on the side rather than on the back.
Snoring is worse when sleeping on the back

A Simple Guide to Obstructive Sleep Apnea

A Simple Guide to Obstructive Sleep Apnea
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What is Obstructive Sleep Apnea?
--------------------------------------

Obstructive Sleep Apnea (OSA) is the absence of respiratory airflow (for 10 seconds or more) during sleep despite respiratory effort due to upper airway obstruction.

Patients with OSA do not have adequate sleep and may have problem staying awake during the day posing problems in their employment during the day and keeping their family awake at night.

What are the causes of Obstructive Sleep Apnea?
-----------------------------------------------------

Obstruction causes:
----------------------------

1.Inadequate muscle tone of the palate, tongue and pharynx leads to airway collapse during inspiration during the deep stage sleep.

2.bulky tissue in the upper respiratory airway(adenoids and tonsillar hypertrophy, cysts and tumors)

3.excessive soft palatial tissue or long uvula

4.receding chin resulting in a backward prolapsing tongue

5.anatomical abnormalities in the nose(deviated nasal septum, hypertrophied inferior turbinates) or congested nasal passages (allergies, sinusitis, nasal polyps)

Systemic disorders:
-------------------------

1.Hypothyroidism

2.Acromegaly

3.Alcohol

4.Sedatives

5.Obesity

What are Signs and symptoms of Obstructive Sleep Apnea?
-------------------------------------------------------------

Symptoms:

1.snoring present in 20% of men and 5% of women at age 30-35 years.
At age 60years or more, 60% of men and 40% of women snore habitually

2.unrefreshed sleep

3.daytime sleepiness

4.poor concentration

5.forgetfulness

6.morning headaches

7.dryness of mouth in the morning

8.irritability

9.depression

10.sexual dysfunction

Signs:

1.Enlarged nasal turbinates, polyps , and nasal blockage

2.Enlarged tonsils and adenoids

3.Long uvula

4.large protruding tongue


How is the diagnosis of Obstructive Sleep Apnea made?
--------------------------------------------------------------

A.Symptoms of snoring, nasal congestion and inadequate sleep

B.observation of airway obstruction during sleep

C.Sleep study using monitoring devices such as

1.electroencephalogram(EEG)- brain waves

2 electro-oculogram(EOG) - ocular or eye muscle movement

3.Electro-myogram (EMG) - chin and leg movement

4.Electrocardiogram(ECG) - electrical activity of the heart

5.Blood oxygen studies

6.Body position

7.Nasal and oral airflow

8.Thoracic movement

9.abdominal movement

10.Snoring sounds


What are the complications of Obstructive Sleep Apnea?
-----------------------------------------------

1.higher risk of hypertension

2.cardiovascular disease

3.Congestive heart failure

4.cardiac arrhythmias

5.cerebrovascular accidents

What is the treatment of Obstructive Sleep Apnea?
------------------------------------

Non Surgical treatment:
--------------------------

1.Continuous Positive Airway Pressure(CPAP)
CPAP administered by mask through the nose is the single most effective and least invasive treatment for OSA.
It can improve all the bad effects of OSA.

2.Oral appliances which pushes the mandible forward and prevent it from falling open during sleep

3.Nasal Congestion treatment:
Patients with nasal congestion and blockage should be treated with antihistamine and decongestant

4. Weight reduction:
Any obese patients should have at least 10% of his weight reduced over a 6 months period

Surgical Treatments:
--------------------------

1.Surgery on the upper pharyngeal airway (uvula and palate)

a.Radiofrequency reduction is indicated in simple snorer or mild OSA.

b.Uvulopalatopharyngeal (UPPP) surgery includes uvulectomy, palatal releasing and shortening incisions.

2.Surgery of the Tongue base:
Radiofrequency reduction is done for mild cases.
Advancement of the tongue, hyoid suspension is done under general anesthesia. All these enlarge the posterior airway space.

3.Maxillomandibular Advancement:
This is the most effective surgical procedure for treatment of OSA.
It causes enlargement of the pharyngeal and hypopharyngeal airway by physically expanding the skeletal framework.

What is the prognosis of Obstructive Sleep Apnea ?
--------------------------------------------------------

This depends on the severity of the condition but is generally good.

What are the Preventive measures taken for Obstructive Sleep Apnea ?
---------------------------------------------------------------------

1.Lose weight in obese individual with OSA

2.Healthy lifestyle with balanced diet and exercise.

3.Neck elevation

4.Avoid alcohol