Snoring & Sleep Apnea

Snoring occurs when air moving through the nose and throat during sleep passes through a narrowed area which cause the structures to vibrate and rattle causing the familiar sound of snoring.

What is Sleep Apnea?

Obstructive Sleep Apnea(OSA) is a common disorder involving collapse of the upper airway during sleep. This repetitive collapse results in frequent awakenings and tiredness during the day, even with enough sleep time. It is  recommended that evaluation for primary surgical treatment be considered in select patients who have severe obstructing anatomy that is surgically correctable (e.g., large tonsils blocking the throat) and in patients in whom continuous positive airway pressure (CPAP) therapy is inadequate.

continuous positive airway pressure (CPAP) "is the first line of treatment," In most patients with moderate to severe OSA. Successful long term treatment of OSA with CPAP is difficult to achieve, and fewer than 50% of patients on CPAP are adequately treated, as defined by 4 hours of use 70% of nights. Other treatment options must be available to patients with OSAS. 

Watch this video on OSA and CPAP:

Surgical procedures considered as a secondary treatment for OSA when:
  • The outcome of CPAP therapy is inadequate, such as when the patient is intolerant of CPAP, or CPAP therapy is unable to eliminate OSA.
  • When there is an inadequate treatment outcome with an oral appliance (OA), when the patient is intolerant of the OA, or the OA therapy provides unacceptable improvement of clinical outcomes of OSA (Consensus).
  • When obstructive anatomy or functional deficiencies compromise other therapies or to improve tolerance of other OSA treatments Surgery for OSAS has been shown to improve important clinical outcomes including survival and quality of life.

Surgical Management

Somnoplasty - is an unique surgical method for reducing habitual snoring by removing tissues of the uvula and soft palate. Unlike other approaches (such as laser, or evasive surgery), somnoplasty uses very low levels of radio frequency heat energy to create finely controlled localized burn-areas beneath the lining (mucosa) of the soft tissues of the throat. These burn- areas are eventually reabsorbed by the body, shrinking the tissue volume, opening the passageway for air, and thereby reducing symptoms of snoring. Somnoplasty is performed under local anesthesia in an outpatient setting and takes approximately 30 minutes.

Uvulopalatopharyngoplasty (UPPP) - Uvulopalatopharyngoplasty (UPPP) is a long and fancy term to describe a surgery aimed at preventing collapse of the palate, tonsils, and pharynx which is common in sleep apnea. UPPP is most successful in patients who have large tonsils, a long uvula (the most posterior part of the palate that hangs down in the back of the throat), or a long, wide palate. It also is more successful in patients who are not obese.

An UPPP operation is performed under general anesthesia and the patient is completely asleep. In simple terms, the tonsils are removed, the uvula is removed, and the palate is trimmed. All of the surgical cuts are closed with stitches. UPPP usually requires an over night stay in the hospital to monitor breathing and to control pain. UPPP is a painful operation similar to a tonsillectomy in an adult (tonsillectomy in children is less painful). Frequently, it is recommended for patients undergoing UPPP to take 10 days to two weeks off from work. In the post-operative period, people usually are on a liquid only diet and require liquid pain medication.

A UPPP is successful 50%-60% of the time in preventing or decreasing obstructive sleep apnea. Studies also have demonstrated a decrease in mortality and decrease in risk of car accidents after UPPP. Some people who have a "successful UPPP" and fewer episodes of apnea, still have to use a CPAP after surgery to completely control their obstructive sleep apnea.

Before Surgery

After Surgery

After a thorough history and physical examination an overnight sleep study may be recommended to determine if sleep apnea is present. A new device, which allows home sleep study, is available. This is more convenient and less expensive for most patients. Please watch the video on the home sleep study device.

Wathch this video how to use the WM ARES Home Sleep Test Device:

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