Obstructive Sleep Apnea Syndrome (OAS), or sleep apnea, is a common disorder that disrupts sleep. Five or more pauses or shallow breaths per hour lasting more than ten seconds characterize this condition. When breathing resumes, it is often accompanied by a gasping or choking sound and a loud snort.
Sleep apnea often goes undiagnosed. Many people who have sleep apnea don’t realize they have it because it only occurs during sleep. A family member or bed partner may first notice the signs of sleep apnea.
The mechanism of sleep apnea is similar to snoring but is more severe. Enlargement of the soft palate and uvula, the tonsils and adenoids, and the tongue base may play a significant role. Obesity, the use of alcohol, or the administration of sedatives at night may worsen symptoms.
Obstructive sleep apnea is the most common type of sleep apnea. This means that the airway has collapsed or is blocked during sleep. Central sleep apnea is less common. Central sleep apnea usually results from a neurologic disorder. This happens when the area of the brain that controls breathing doesn’t send proper signals to the breathing muscles, leading to a stop in breathing for brief periods. Central sleep apnea can occur with obstructive sleep apnea. Snoring doesn’t typically happen with central sleep apnea.
Symptoms of sleep apnea can include:
- Excessive daytime tiredness or sleepiness
- A feeling of “dullness,” or of not being capable of maximum performance
- Napping during work hours
- Falling asleep while driving or during sedentary activities
Sleep apnea is a chronic condition that requires long-term team oriented management which includes the care of an experienced ENT specialist. Untreated sleep apnea can increase the risk of heart attack, obesity, diabetes, and hypertension. It also increases the chance of having a work-related or driving accident.
Therapy for obstructive sleep apnea is directed at either creating a larger oropharyngeal airway, or toward using measures to keep the present airway more patent during sleep.
Non-surgical treatments for sleep apnea can include:
- Oral repositioning devices to bring the tongue and jaw forward
- Continuous Positive Airway Pressure (CPAP) machines that deliver air pressure to stent the airway open
- Weight loss
- Positional change while sleeping, directed toward keeping patients from lying on their back
If non-surgical treatment for sleep apnea doesn’t produce desired results, an otolaryngologist may recommend a surgical solution. He will carefully evaluate the sleep study results, the severity of the sleep apnea, the physical structure of the upper airway and the medical history before developing a treatment plan. The goal of any surgery is to prevent obstructions from occurring, usually by widening the airway.
There are several surgical treatments for sleep apnea; an otolaryngologist will typically perform the uvulopalatopharyngoplasty. This may be done with or without corrective nasal surgery.
Uvulopalatopharyngoplasty (UPPP or UP3) is a common sleep apnea procedure used to remove the tonsils, uvula, and adjacent areas of the soft palate to widen the airway. In general, patients with greater degrees of obstruction pre-operatively are more likely to achieve a significant benefit following the procedure. Unfortunately, the procedure is usually associated with significant post operative discomfort, although this can be readily managed with oral pain medications. An overnight stay in the hospital is required in most instances.