Sleep Study and Sleep Apnea

Its a potentially serious disorder that causes breathing to stop and start during sleep.
It occurs when the muscles in the back of your throat relax too much, narrowing the airway for 10seconds or longer. Oxygen levels drop & there is rise in levels of Carbon dioxide which is sensed by brainstem and there is awakening. This may happen multiple times at night leading to interrupted sleep.

1. Obesity
2. Narrowed airway due to enlarged tonsils or adenoids.
3. Hypertension
4. Chronic nasal congestion
5. Smoking
6. Diabetes
7. Sex: twice common in men
8. Asthma

1. Daytime fatigue & sleepiness
2. Cardiovascular problems: Hypertension, heart attack, heart failure, pulmonary hypertension & Arrhythmias.
3. Sedatives & narcotics will worsen OSA.
4. Eye problems: There is some correlation with Glaucoma.
5. Sleep deprived partners

1) Loud snoring
2) Excessive daytime sleepiness
3) Episodes of apnoea( cessation of breathing) during sleep.
4) Dry mouth
5) Sore throat
6) Morning headache
7) Difficulty in concentration
8) Mood changes, irritability
9) Decreased libido
10) Night time sweating

1) Loud snoring that disturbs others sleep
2) Waking up choking
3) Excessive daytime drowsiness causing tiredness, fatigue. You may fall asleep while you are working, watching TV or even driving.

Surgical treatment for OSA provides long-term benefits in selected patients.
Predictors of benefit are inconsistent across studies but generally include lower body mass index (BMI) and less complicated obstruction.

NASAL SURGERY as a single intervention does not reliably treat OSA. The primary goal of nasal procedures in the context of OSA is to improve CPAP, oral appliance, or other surgery effectiveness in selected patients affected by nasal obstruction. Nasal surgery can improve CPAP tolerance, reduce CPAP pressure requirements, or complement oral appliance and other surgical therapies. Examples of nasal procedures used for this purpose include turbinate reduction, septoplasty, and nasal valve surgery.

UVULOPALATOPHARYNGOPLASTY (UPPP) and UPPP variants are the most common surgical procedures for OSA, based on the fact that upper pharyngeal obstruction is the most common anatomic airway abnormality. UPPP frequently improves the physiologic abnormality of OSA as well as clinical symptoms, but the degree of polysomnographic benefit is variable, and cures are rare. Important adverse effects include chronic mild dysphagia in up to one-third of patients. Simple tonsillectomy in selected patients with tonsillar hypertrophy and otherwise favorable anatomy (eg, small tongue) is associated with a high rate of success.

LOWER PHARYNGEAL AND LARYNGEAL PROCEDURES aim to improve the retrolingual and/or laryngeal airway. Some procedures occur in the lower pharyngeal airway (eg, midline glossectomy, epiglottidectomy), some occur at adjacent sites with effects on the lower pharyngeal airway (eg, genioglossus advancement), and others aim to reduce, advance, or stabilize the tongue base.

Global upper airway procedures improve multiple levels of airway obstruction. Maxillomandibular advancement is generally associated with a large degree of improvement in polysomnographic parameters of OSA. However, it is a major procedure that is typically reserved for patients with persistent, significant OSA following other site-directed surgical treatments or with baseline maxillary or mandibular hypoplasia.

Tracheotomy is usually reserved for patients with severe OSA who fail CPAP therapy and who have critical comorbidities.
Upper airway stimulation via an implantable neurostimulator is an emerging novel treatment of the upper and lower pharyngeal airway in selected patients