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Snoring and Obstuctive sleep apnea

Posted Jul 10 2010 12:00am

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Let's define apnea first:Apnea is the cessation of airflow at the nostrils and mouth for at least 10 seconds in adults.
What is sleep apnea ?It is the stop of breathing during sleep for more than 10 seconds

Types of sleep apnea:1. Obstructive sleep apnea: there is apnea but the individual continues to do inspiratory effort to overcome this apnea2. Central sleep apnea: there is apnea but all inspiratory efforts are abolished3. Mixed apnea Today we will explain more about Obstructive sleep apnea as it is more commonly encountered. 
As the name suggests, there is an obstruction that is associated with this type. 
The following is a small diagram to illustrate some important landmarks during this topic 

So how this obstruction can lead to apnea ?
If there is an obstruction above the level of the larynx, it will cause collapse of the oropharynx during inspiration during sleep --> Apnea

The increased carbon dioxide in the blood will cause stimulation of the nervous system that will cause arousal from sleep. It is then when the airway gets patent again and the individual regains normal respiration and then falls sleep again. This cycle can repeat more than once in a single night which is affects the normal sleep of the individual.  What can cause supra-laryngeal obsturction?In the nose, there can be polyps or a deviated septum. Also tonsils, adenoids, large tongue can cause obstruction
So who are more prone to get obstructive sleep apnea ?Obese individuals and male sex are more prone to get obstructive sleep apnea
Clinical picture of obstructive sleep apnea:1. Snoring: it is a vibration of the soft palate, lateral pharyngeal wall and base of the tongue. This vibration will lead to a noisy breathing. 
2. Obstructive episodes: an episode of apnea that may last from 10 - 60 seconds. During this period, the individual will be exerting a marked respiratory effort to regain the normal respiration3. Excessive day time sleepiness: due to affection of the normal night sleep4. Morning headaches and impaired concentration
What is the treatment one should have to get rid of obstructive sleep apnea ?There is a non-surgical and a surgical treatment
Non-surgical treatment:1. Lose weight2. Avoid alcohols and sedatives3. Avoid lying supine4. Continous positive airway pressure: the patient will wear a mask connected to a pump that will blow air at a higher pressure to prevent the collapse of the airway
Surgical treatment:Aims at removing the cause of obstruction. If the cause is tonsils and adenoids, then an adenotonsillectomy is done.An important operation is being done in many patients nowadays which is called Uvulo-Palato-Pharyngoplasty (UPPP). Done by laser involves removal of the tonsils, trimming of the pillars, removing the uvula and a part of the soft palate, therefore creating a wider airway passage. 

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