Sleep Apnea / Throat
Snoring and sleep apnea affects from 10- 30% of the population. Snoring alone can be a major disturbance to both the patient and bed-partner, and can have a significant negative impact on personal relationships. Sleep apnea, which involves the transient obstruction of breathing leading to arousals, often going unnoticed, may also be present and contribute to daytime fatigue, worsened cognitive function, and poor cardiovascular health. Snoring and obstructive sleep apnea arise from the collapse or narrowing of normal anatomic structures in the upper airway, which may occur at the level of the nose, nasopharynx ( the back of the nose and location of the adenoids ), soft palate, tonsils, tongue base, and larynx. Diagnosis is based on the history of symptoms provided by the patient, examination of the upper airway structures, and a sleep study which is done in an overnight laboratory or home monitoring. Treatment can be surgical or nonsurgical, depending on the severity, preferences of the patient, and individual anatomy. Some of the procedures we can do to improve snoring and sleep apnea are listed below, and can be used alone or in combination.
Medical Management – This is an option depending on patient preferences. CPAP ( continuous positive airway pressure ) involves the use of a tight fitting nasal or mouth mask worn at night which effectively stents open the airway with pressurized air. In fact as long as the mask fits properly and is worn, this can be very successful, however it is limited by inconvenience, disruption of bed partners, and comfort. Nasal steroid sprays can often improve nasal breathing if there is mild nasal obstruction. Oral appliances called mandibular advancement devices can be worn in the mouth at night when tongue base collapse contibutes to sleep apnea.
Nasal surgery – Nasal obstruction can contribute to altered airflow, mouth breathing, and worsened obstructive symptoms. Correction surgically may involve straightening the septum ( septoplasty ), shrinking the turbinates ( turbinoplasty ), nasal valve surgery, and adenoidectomy. Turbinoplasty can be done in the office setting.
Palatal procedures – The soft palate and uvula can often be thickened and large, and obstruct air as itflows past it from the nose and mouth. Its vibrations contribute to the sound we hear as snoring. A minimally invasive approach to stiffen the soft palate and improve snoring is the pillar implant system, in which small synthetic pillars which are only several millimeters in diameter are inserted into the soft palate and which remain in place to provide support to the structure, so that it is less floppy. This can be done in the office or in the operating room. Other options are using a laser in the office to induce scarring, with the similar goal of causing stiffening and decreased vibration
Tonsillar and Palatal surgery – ( Uvulopalatoplasty ) Tonsillectomy alone can significantly improve symptoms, but is often combined with palatal surgery depending on anatomy. Uvulopalatoplasty is a procedure which trims off excess soft palate tissue and resuspends this to tighten the area, which is done along with tonsillectomy can further open up the oropharynx to airflow. This can be very successful for mild to moderate sleep apnea.
Tongue base surgery and procedures – Depending on the individual anatomy, in some patients a large tongue can contribute to airway collapse and sleep apnea. In selected patients procedures which remove, resuspend, or shrink the base of tongue tissue can be used to improve airflow. On the less invasive spectrum is radiofrequency ablation, in which a needle probe is used to heated up areas of the tongue base for several seconds to induce scarring and shrinkage. Tongue base reduction with surgery to remove tonsillar tissue in the area can also be used, using either endoscopes or a microscope, which can be performed through the mouth.
Genioglossus advancement is a procedure in which the tongue is pulled forward and resuspended by making an incision in the mouth or lower chin and advancing the bony muscle attachments of the tongue. In some cases of severe tongue base collapse and a small or retropositioned mandible, orthognathic surgery can be undertaken to surgically pull forward the facial bones.