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Snoring and Sleep Apnoea

By Dr Kaustabh Kalita
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People who snore loudly are often the target of bad jokes and middle-of-the-night elbow thrusts. But snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder � obstructive sleep apnoea (OSA).

It is estimated that approximately 30-50 per cent of the Indian population snore at one time or another, some significantly. Severe snoring can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one�s own snoring. It eventually requires treatment, and there are several options available for chronic snorers.

Symptoms of snoring and sleep apnoea

The �STOP�BANG� questionnaire from the American Society of Anesthesiologists:

1. Do you Snore loudly?

2. Do you often feel Tired, fatigued, or sleepy during daytime?

3. Has anyone Observed you stop breathing during your sleep?

4. Do you have high blood Pressure?

5. Is your BMI more than 35 kg/m2?

6. Is your Age over 50 years?

7. Is your Neck circumference greater than 40 cm?

8. Is your Gender male?

If you answered �Yes� to three or more of the above questions, you may be at a high risk of OSA.

Common causes of snoring and sleep apnoea

* Enlarged tonsils and/or adenoids

* Bulky tongue

* Deviated nasal septum

* Hypertrophied turbinates

* Sinonasal polyposis/Sinusitis

* Obesity

* Inward Jaw

* Fat neck

Diagnosing sleep disorders

If you exhibit several OSA symptoms, it is important that you visit your ENT surgeon for a complete examination and accurate diagnosis.

At your first visit, your doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. If the doctor suspects a sleep disorder, you will be referred for a sleep study, which will monitor your night-time sleep patterns through special tests called Polysomnography or Sleep Study and Sleep Endoscopy.

Polysomnography will require you to sleep at the clinic overnight while a computer monitors your sleep pattern and gathers data about the number and length of each breathing cessation or other problems that disturb your sleep following which a Sleep Endoscopy which simulates your sleep cycle along with examination by a flexible endoscope to see the sites of obstruction.

Treatment for snoring and sleep apnoea

Obstructive sleep apnoea can be effectively treated. Depending on whether your OSA is mild, moderate or severe, your doctor will select the treatment that is best for you.

Some non-medical treatments that may alleviate snoring:

* Weight loss � as little as 4-5 kg may be enough to make a difference.

* Change of sleeping position � Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.

* Avoid alcohol, caffeine and heavy meals � especially within two hours of bedtime.

* Avoid sedatives � which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.

* C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) � A C-PAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe snoring/sleep apnoea.

Surgery for sleep apnoea

* Uvulopalatopharyngoplasty (UPPP) � UPPP is usually performed on patients who are unable to tolerate the C-PAP, with a success rate of 70-80 percent.

* Zetaplasty � This is a modification of the UPPP and is a newer technique used nowadays. It is supposed to give excellent results in indicated cases.

* Laser-Assisted Uvulopalatoplasty (LAUP) � A surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This new technique is widely practised and has success rates of around 75-85 per cent.

* Maxillomandibular Advancement (MMA) � A procedure that surgically moves the upper and lower jaws forward. This has a success rate of around 55-90 per cent.

* Tongue Base Reduction � This is a minimally invasive procedure to reduce the amount of tissues in cases of a bulky tongue. Most often it can be done as an outpatient procedure.

* Hyoid suspension � A surgical procedure in which the hyoid bone and its muscle attachments to the tongue and airway are pulled forward with the aim of increasing airway size.

Other procedures commonly performed may be a Septoplasty with Turbinoplasty for nasal obstruction or an Adenotonsillectomy for children in whom this condition may be very common.

(The writer is consultant, ENT and head and neck surgeon at Ayursundra Superspecialty Hospital, Garchuk, Guwahati)

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Snoring and Sleep Apnoea

People who snore loudly are often the target of bad jokes and middle-of-the-night elbow thrusts. But snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder � obstructive sleep apnoea (OSA).

It is estimated that approximately 30-50 per cent of the Indian population snore at one time or another, some significantly. Severe snoring can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one�s own snoring. It eventually requires treatment, and there are several options available for chronic snorers.

Symptoms of snoring and sleep apnoea

The �STOP�BANG� questionnaire from the American Society of Anesthesiologists:

1. Do you Snore loudly?

2. Do you often feel Tired, fatigued, or sleepy during daytime?

3. Has anyone Observed you stop breathing during your sleep?

4. Do you have high blood Pressure?

5. Is your BMI more than 35 kg/m2?

6. Is your Age over 50 years?

7. Is your Neck circumference greater than 40 cm?

8. Is your Gender male?

If you answered �Yes� to three or more of the above questions, you may be at a high risk of OSA.

Common causes of snoring and sleep apnoea

* Enlarged tonsils and/or adenoids

* Bulky tongue

* Deviated nasal septum

* Hypertrophied turbinates

* Sinonasal polyposis/Sinusitis

* Obesity

* Inward Jaw

* Fat neck

Diagnosing sleep disorders

If you exhibit several OSA symptoms, it is important that you visit your ENT surgeon for a complete examination and accurate diagnosis.

At your first visit, your doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. If the doctor suspects a sleep disorder, you will be referred for a sleep study, which will monitor your night-time sleep patterns through special tests called Polysomnography or Sleep Study and Sleep Endoscopy.

Polysomnography will require you to sleep at the clinic overnight while a computer monitors your sleep pattern and gathers data about the number and length of each breathing cessation or other problems that disturb your sleep following which a Sleep Endoscopy which simulates your sleep cycle along with examination by a flexible endoscope to see the sites of obstruction.

Treatment for snoring and sleep apnoea

Obstructive sleep apnoea can be effectively treated. Depending on whether your OSA is mild, moderate or severe, your doctor will select the treatment that is best for you.

Some non-medical treatments that may alleviate snoring:

* Weight loss � as little as 4-5 kg may be enough to make a difference.

* Change of sleeping position � Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.

* Avoid alcohol, caffeine and heavy meals � especially within two hours of bedtime.

* Avoid sedatives � which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.

* C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) � A C-PAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe snoring/sleep apnoea.

Surgery for sleep apnoea

* Uvulopalatopharyngoplasty (UPPP) � UPPP is usually performed on patients who are unable to tolerate the C-PAP, with a success rate of 70-80 percent.

* Zetaplasty � This is a modification of the UPPP and is a newer technique used nowadays. It is supposed to give excellent results in indicated cases.

* Laser-Assisted Uvulopalatoplasty (LAUP) � A surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This new technique is widely practised and has success rates of around 75-85 per cent.

* Maxillomandibular Advancement (MMA) � A procedure that surgically moves the upper and lower jaws forward. This has a success rate of around 55-90 per cent.

* Tongue Base Reduction � This is a minimally invasive procedure to reduce the amount of tissues in cases of a bulky tongue. Most often it can be done as an outpatient procedure.

* Hyoid suspension � A surgical procedure in which the hyoid bone and its muscle attachments to the tongue and airway are pulled forward with the aim of increasing airway size.

Other procedures commonly performed may be a Septoplasty with Turbinoplasty for nasal obstruction or an Adenotonsillectomy for children in whom this condition may be very common.

(The writer is consultant, ENT and head and neck surgeon at Ayursundra Superspecialty Hospital, Garchuk, Guwahati)

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