SNORING AND SLEEP APNEA SURGERY

Respiratory disorders during sleep (sometimes known as sleep disordered breathing – SDB) in adults are a controversial topic and under constant evolution.

 

There are some common concepts that should be differentiated: primary snoring (simple snoring), obstructive sleep apnea (breathing pauses with lack of air flow) and non-respiratory sleep disorders.

The main complaints for SDB include snoring (observed by others), excessive daytime sleepiness, fatigue, morning headaches, concentration and memory deficits, irritability or social / marital problems related to snoring.

The diagnosis and treatment of sleeping disorders lie in the frontier of many medical specialities, which means a multidisciplinary approach is needed, maybe including Otorhinolaryngology (ORL), Neurophysiology, Pulmonology, Psychiatry, Maxillofacial surgery, Dentistry and Nutrition.

The role of ORL in the treatment of SDB is important, although frequently overlooked by other medical specialties. The ORL doctor has the unique capacity to assess both the anatomy and physiology of the upper respiratory tract (nose, nasopharynx, oropharynx and mouth, larynx and hypopharynx) and therefore identify potential sites of obstruction, as well as treatment as a whole or individually.

There is no universal solution for SDB because the anatomy and physiology is different from one individual to another. This is why clinical history and physical examination is not enough, which elevates the pivotal role in complementary diagnostic tools, such as: polysomnography, multiple sleep latency test, computed tomography (CT) of the nose and pharynx, drug induced sleep endoscopy (DISE).

After careful analysis of all these elements, treatment may include simple general measures, such as promotion of sleep hygiene, or weight loss; control of co-morbidities (allergies, laryngopharyngeal reflux, asthma…), domiciliary respiratory ventilation (splinting the airway with continuous positive airway pressure – CPAP), oral devices for mandibular advancement or surgical treatment.

Surgical treatments may include nasal or sinus, pharyngeal, laryngeal surgery or even implanting a hypoglossal nerve neuromodulator.

Each treatment is individualized and must involve an evaluation by an otolaryngologist.

In Children, breathing disorders during sleep have a different approach than in adults. Their symptoms are usually restless sleep, snoring with dyspnea, bedwetting, night sweats, morning headaches, hyperactive children, attention deficit disorder, among others. It is often caused by big adenoids and tonsils and the problem is solved with their removal.