Snoring and Sleep Apnea

Snoring and Sleep Apnea are two common ENT problems. Snoring is caused by obstruction in the nose and throat and obesity. It is essentially noise. If the nose is congested by swollen tissue due to allergy or infection or there is extra weight, there is a resistance to airflow that causes noise – snoring.

Sleep apnea is a serious condition that causes physiologic changes.  Because of severe airflow compromise there is breath holding, gasping, and choking, mouth breathing in addition to snoring.  Sleep apnea unlike snoring is characterized by a decrease in oxygen content that can stress the heart and cause changes in blood pressure. In severe cases of oxygen deprivation, high blood pressure, heart disease, and stroke can occur. In milder cases there can be changes in the behavior (depression, hyperactivity, aggression), problems with concentration and performance at work and daytime sleepiness.

Enlarged tonsils and adenoids must be ruled out as a cause of snoring and sleep apnea.  They are part of the immune system and become enlarged when the child has recurrent infections and/or untreated allergy.  When they become enlarged they block movement of air through the nose and upper throat.

Weight loss is also an important weapon to control snoring and sleep apnea.

Diagnosis is confirmed using:

  1. Physical examination to rule out a deviated septum, swollen nasal tissue, enlarged tonsils, elongated palate tissue
  1. Endoscopy a thin flexible fiberoptic telescope is inserted through the nose into the throat to evaluate the size of the airway and the degree of the collapse of the throat when the patient breathes.  This examination will simulate what happens when a patient snores at night.  If the soft tissues in the throat collapse closing off the airway below the palate, surgical intervention alone will likely not be curative.
  1. Sleep study an overnight test that evaluates what happens when a patient sleeps at night.  Various measurements are taken (including heart rate, blood pressure, blood oxygen level, brain waves and how many times the patient stops breathing during the study).  It can definitively determine if the patient has sleep apnea and how severe it is.

Treatment of snoring usually involves medical management with:

  1. Avoidance of things that cause allergy with nasal congestion such as dust pet dander, dairy products (milk, cheese and yogurt) and wheat
  2. Use of nasal steroid sprays, decongestants and/or antihistamines
  3. Continuous Positive Airway Pressure (CPAP) machine. Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered the most effective non-surgical treatment for the alleviation of snoring and obstructive sleep apnea. CPAP is used nightly.  In addition to its use patients should make lifestyle changes to improve the effectiveness of treatment. Changes include weight loss, smoking cessation and alterations in diet

If medical management fails surgery Adenoidectomy and/or Tonsillectomy and/or Uvulopalatoplasty via (surgical shortening and stiffening of the soft palate and uvula) please hyperlink to the bold text http://www.tonsil.org/ is the treatment of choice. Coblation http://www.arthrocare.com/ent/ent_pat_patients.htm is a minimally invasive technique that uses radiofrequency surgery to remove the tonsil and adenoid tissue.  There is minimal heat and no charring of tissue.  This results in a faster recovery with less pain. 

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