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Snoring and Obstructive Sleep Apnea

Overview of Disordered Sleep Breathing

Snoring and Obstructive Sleep Apnea (OSA) are just two sub categories of what is formally called Disordered Sleep Breathing. Obstructive Disordered Sleep Breathing is more common than diabetes with a prevalence of mild disease in 24% of men and 9% of women, 30-60 years of age. OSA associated excessive daytime sleepiness affects 7% of adult men and 5% of adult women. It is a disease that gets worse with age.

3% of children are affected by Disordered Sleep Breathing and has strong correlation to Attention Deficit Disorders, Oppositional Defiant Behavior, and poor scholastic achievement.

In adults, common signs and symptoms of Obstructive Disordered Sleep Breathing are:

  • Loud disruptive snoring
  • Shirt collar size 16 or above
  • Observed obstructions while sleeping
  • Gasping or startled awakenings
  • Awakening with a dry mouth
  • Morning headache
  • Sleep anxiety and insomnia
  • Excessive daytime sleepiness
  • Attention deficit and poor mental focus
  • Irritability or impatience

Snoring Overview

Dr. Jelic views his patient’s airway as a continuum between a wide open healthy air way and a completely blocked airway. Snoring is like the little brother of Obstructive Sleep Apnea. Snoring is a warning sign that the airway has moved down the path from a wide open healthy airway, towards a dangerously obstructed airway. When the airflow is blocked completely, this is termed an apnea (no breath) and snoring is now called Obstructive Sleep Apnea. The question to be answered in any snoring patient: is the degree of blockage significant to health and/or quality of life?

Surveys such as the Epworth Sleepiness Questionnaire (or Pediatric Sleep Questionnaire for patients less than 18 years old) are useful screening tool for Disordered Sleep Breathing.  The only way to determine if your snoring is significant, or if your disordered sleep breathing is due to another etiology, such as a neurologic cause, is a sleep test (formerly: polysomnogram).

Consequences of untreated OSA

Untreated sleep apnea can cause cardiopulmonary diseases such as hypertension, congestive heart failure, stroke and irregular heart rhythms including ventricular fibrillation (“Sudden Death”). Moreover, untreated sleep apnea is responsible for memory and cognitive problems, depression, rapid mood swings, impotency, and ultimately impairment with interpersonal relations and job performance. Studies have also demonstrated people with untreated sleep apnea have motor vehicle crashes seven times higher than the  average person.

Typical medical conditions associated with untreated Disordered Sleep Breathing include:

  • High blood pressure
  • Coronary Arterial Disease
  • Irregular heart beat
  • High incidence of strokes
  • Diabetes
  • High cholesterol
  • Chronic liver disease
  • Heart burn / reflux disease
  • Asthma and COPD
  • Memory problems and clouded thinking
  • High incidence of motor vehicle accidents
  • Insomnia
  • Anxiety /depression
  • Frequent urination at night
  • Impotence and loss of libido

Treatment for Snoring and Obstructive Sleep Apnea

Because snoring is on a continuum to OSA, it should not be surprising that many treatment options may be applied to both conditions. Sleep apnea and snoring can be remedied by a number of non-invasive, minimally invasive, and surgical procedures designed to improve the size and muscle tone of a patient’s airway.

Non-invasive procedures

Oral appliances – also called mandibular repositioning device (MRD), mandibular advancement device (MAD) are indicated for snoring and mild to moderate OSA.

Oral appliances are generally well tolerated.  Side effects such as sore teeth, temporomandibular joint pain, and myofascial pain, usually resolve within the one or two week adaptation period. 10-12% of people will need to discontinue use of an oral appliance due to significant TMJ symptoms or changes in dental occlusion.

** It is important to understand that the over the counter devices sold on television or in corner drug stores can be used to treat snoring only.  They are not approved for people with OSA. It is always recommended to have a sleep study to accurately understand your condition before engaging in non-treatment of a potentially life threatening disease process.  

Minimally-invasive procedures

Radiofrequency Tissue Ablation – a specially designed needle passes radiofrequency waves to heat and remove tissue in the soft palate or base of tongue. Treated tissue is resorbed by the body and then the healing process causes tissue contraction and further opens the adjacent airway.

Risks are usually self-limiting and include bleeding, infection, ulceration, sore throat, and difficulty swallowing, and numbness/tingling in tongue.

Surgery

Surgery will be advantageous for some patients.  Each patient however, has a uniquely shaped nose and throat. In addition, OSA often has a multifactorial etiology.  As a result, no single surgical procedure is a guaranteed success.  Surgical procedures may therefore, be combined to address this multifactorial reality.

Before a surgical option is considered, Dr. Jelic will review your sleep study and do an examination to identify any potential abnormal  airflow between the nose and the lungs. He has been specifically trained to perform the following procedures:

  • Soft Palate or Uvula reduction, repositioning, or in some cases removal
  • Tongue reduction – this procedure removes tissue from the top, midline portion of the tongue and reduces the width and length of the tongue with minimal effects on taste or function.
  • Genioglossus Advancement – the genioglossus is the muscle that attaches your tongue to the lower jaw. This procedure will not change your appearance, but will move the genioglossus attachment forward, tightening the tongue tendon. This tension pulls the tongue away from the back of the throat and keeps the tongue from falling back during sleep and blocking the upper breathing passage.
  • Maxillomandibular advancement (MMA) – also called orthognathic corrective jaw surgery, is the most successful surgical procedure for the correction of Obstructive Sleep Apnea. In MMA, corrective jaw surgery is performed to move the patient’s upper and lower jaws forward, thus moving the tissues of the tongue and palate with it.

Compared to all surgical procedures MMA creates the greatest degree of improvement in airflow through both the nose and mouth. It also offers significant additional dental, occlusal, and facial aesthetic advantages. In many cases of moderate to severe obstructive sleep apnea, it is the only practical surgical option for relieving OSA.

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