Snoring and sleep disorders
THE SIGNIFICANCE OF THE SNORING
If you experience a breathing disorder (short-term cessation) with snoring during sleep, you probably have a disorder professionally called Obstructive Sleep Apnea Syndrome (OSAS) or Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). In addition to snoring, sleep disorders can also occur. Such a disorder is uncomfortable for people sleeping next to you. However, it is even more uncomfortable for you due to the consequences after years of sleep apnea and the consequent lack of oxygen (hypoxia). These consequences can also be in the form of heart rhythm disorders and high blood pressure.
Some of the symptoms of this disorder can be dangerous and unpleasant for drivers, especially professionals, and all those whose job requires absolute vigilance and attention. These include morning fatigue, insomnia, daytime sleepiness, and decreased concentration.
Snoring, and the closely related problem of sleep disorders are the most common reasons for consultation. There are often other disorders, such as morning fatigue and insomnia, and sometimes all-day drowsiness. Decreased concentration and sometimes frequent nocturnal enuresis (enuresis) may also occur. Useful information can also be obtained from a close person sleeping with the patient, with the most common complaint being that the family is suffering from unbearable noise. Some patients come for a consultation for surgery to improve the already started CPAP mask treatment (Continuous Positive Airway Pressure).
Many patients with obstructive sleep apnea are overweight and this should be corrected. In addition, if they are smokers, we advise them to stop smoking, as well as reducing alcohol consumption. These are all risk factors that worsen the condition of apnea and jeopardize the effect of treatment.
Additional factors associated with snoring: alcohol, sedatives including antihistamines and some medications to reduce cough, allergic rhinitis and other airway inflammation, increased weight gain and sleep on your back.
SNORING AND SLEEP DISORDER - CONSULTATION
To make a diagnosis and make a decision about surgical treatment, it is necessary to do an ENT examination and determine the location of the narrowing of the airway passage. The examination begins with a view of the pharynx in which an enlarged palate (uvula) can be seen. There may be a flabby, drooping, elongated soft palate, a narrow entry to pharynx. It is not uncommon to have a massive root of tongue (macroglossia) that covers the palate, and additional abundant mucosal pharyngeal folds. Examination of the nose aims for the presence of possible trauma, deviation of the septum and inflammatory and other changes that make breathing through the nose difficult.
To make a safe diagnosis, it is advisable to supplement the otorhinolaryngological examination with a sleep-based breathing test (polysomnography). With this test, we distinguish two types of disorders (i. e. obstructive from central apnea, or mixed type of apnea) and determine the severity of the problem itself.
Sometimes radiological examinations (X-rays or CT scan) are also needed. All this aims to determine the exact location of the narrowing so that it can be adequately treated surgically.
If there is a breathing problem on the nose, it is necessary to do appropriate nasal surgery. Extensive reconstruction in the nasal area (septoplasty) is performed as an independent surgical procedure separate from the operation in the oral cavity and pharynx.
To address snoring due to throat narrowing, the most common surgical procedure is uvulopalatopharyngoplasty (UPPP). It includes shortening of the uvula (uvulectomy), removal of the tonsils (tonsillectomy) and shortening of the soft palate with reconstruction of the palatal arches with resorptive sutures. The goal of the operation is to strengthen the soft palate and palatal arches (like armature) with the resulting scar. This expands the pharyngeal entrance to improve the patient’s breathing, and to get rid of unbearable night noise.