UPPER AIRWAY (BREATHING PASSAGE)
What is Obstructive Sleep Apnea?
Q - Do you have a disturbed sleep? Do you have difficulty in breathing/choking during sleep and snore too loud??
A - Breathing difficulty and choking during the sleep time occurs due to obstructed breathing passage (upper airway). Breathing passage extends from the nose to the back of the nose and extends lower down into the oral cavity (behind the uvula and soft palate) and downwards up to the voice box. There can be narrowing of the airway due to excess soft tissues. The passage of air through this narrow airway leads to excessive vibration of the bulky and flabby soft tissue leading to snoring sound. If the tissues are too bulky then they tend to collapse into the airway (just like when you sip forcibly through a poor quality straw and it tends to collapse). A complete collapse of the soft tissues into the airway leads to complete cessation of breathing and if this event lasts atleast 10 seconds it is termed as an episode of apnea.
A person who has more than 5 apneas per hour of sleep is diagnosed to have sleep apnea. Sleep apnea is most commonly obstructive and the obstruction lies in the upper airway. During an apnea event, the chest wall and abdominal muscles of the patient are hyperactive in order to overcome the obstruction in the upper airway.
Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body ordinarily relaxes during sleep and at the level of the throat the human airway is composed of collapsible walls of soft tissue which can obstruct breathing during sleep. Individuals with low muscle tone and excessive soft tissue around the airway (e.g., due to obesity), and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. Men are more typical sleep apnea sufferers than women and children, although it is not uncommon in the latter two.
Common symptoms include loud snoring, restless sleep, and sleepiness during the daytime. Diagnostic tests include sleep study, upper airway endoscopy, lateral cephalogram (a special x-ray) and a thyroid functions test (as OSA is seen in hypothyroids).
Some treatments involve lifestyle changes, such as avoiding alcohol, muscle relaxants, sedatives at bed time, and losing weight. Many people benefit from sleeping in lateral positions (sleeping on a side), as opposed to supine positions (sleeping on the back), because the gravitational component is smaller in the lateral position. Some people benefit from Oral Appliance Therapy (OAT), the oral appliance is a custom made mouthpiece that shifts the lower jaw forward which prevents the tongue from falling back and thus opens up the airway at the back of the tongue. "Breathing machines" like the continuous positive airway pressure (CPAP) are very helpful. The CPAP machines keep the lax and redundant tissues of the throat splinted apart by a flow of pressurized air into the throat.
For patients who do not tolerate or fail non-surgical measures, there are surgical procedures to remove and tighten the lax redundant soft tissue of the throat and thereby widen the airway. However, surgical treatment needs to be individualized and it depends on the level of obstruction. Often correction of the nasal passages needs to be performed in addition to correction of the throat passage. Septoplasty and laser turbinate surgery improves the nasal airway. Tonsillectomy and Laser uvulopalatoplasty (LAUP) is available to address pharyngeal obstruction. The patients who have obstruction primarily at the tongue base level are advised to use CPAP machines and follow rigorous exercises and dietary plans to reduce weight since the surgical correction at the tongue base level involves major and more complicated surgical procedures (hyoid bone myotomy and suspension, maxillo-mandibular advancement) which are reserved for few selected patients who have failed all the non-surgical methods, have primarily tongue base obstruction and are moderate to severe OSA patients.
Sleep disordered breathing is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, and accidents. When high blood pressure is caused by OSA, it is distinctive in that, unlike most cases of high blood pressure (i.e., essential hypertension), the readings do not drop significantly when the individual is sleeping. Sleep apnea sufferers also have a 30% higher risk of heart attack or premature death than those unaffected.[13]
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| From ear |
Q - Do you have a disturbed sleep? Do you have difficulty in breathing/choking during sleep and snore too loud??
A - Breathing difficulty and choking during the sleep time occurs due to obstructed breathing passage (upper airway). Breathing passage extends from the nose to the back of the nose and extends lower down into the oral cavity (behind the uvula and soft palate) and downwards up to the voice box. There can be narrowing of the airway due to excess soft tissues. The passage of air through this narrow airway leads to excessive vibration of the bulky and flabby soft tissue leading to snoring sound. If the tissues are too bulky then they tend to collapse into the airway (just like when you sip forcibly through a poor quality straw and it tends to collapse). A complete collapse of the soft tissues into the airway leads to complete cessation of breathing and if this event lasts atleast 10 seconds it is termed as an episode of apnea.
A person who has more than 5 apneas per hour of sleep is diagnosed to have sleep apnea. Sleep apnea is most commonly obstructive and the obstruction lies in the upper airway. During an apnea event, the chest wall and abdominal muscles of the patient are hyperactive in order to overcome the obstruction in the upper airway.
Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body ordinarily relaxes during sleep and at the level of the throat the human airway is composed of collapsible walls of soft tissue which can obstruct breathing during sleep. Individuals with low muscle tone and excessive soft tissue around the airway (e.g., due to obesity), and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. Men are more typical sleep apnea sufferers than women and children, although it is not uncommon in the latter two.
Common symptoms include loud snoring, restless sleep, and sleepiness during the daytime. Diagnostic tests include sleep study, upper airway endoscopy, lateral cephalogram (a special x-ray) and a thyroid functions test (as OSA is seen in hypothyroids).
Some treatments involve lifestyle changes, such as avoiding alcohol, muscle relaxants, sedatives at bed time, and losing weight. Many people benefit from sleeping in lateral positions (sleeping on a side), as opposed to supine positions (sleeping on the back), because the gravitational component is smaller in the lateral position. Some people benefit from Oral Appliance Therapy (OAT), the oral appliance is a custom made mouthpiece that shifts the lower jaw forward which prevents the tongue from falling back and thus opens up the airway at the back of the tongue. "Breathing machines" like the continuous positive airway pressure (CPAP) are very helpful. The CPAP machines keep the lax and redundant tissues of the throat splinted apart by a flow of pressurized air into the throat.
For patients who do not tolerate or fail non-surgical measures, there are surgical procedures to remove and tighten the lax redundant soft tissue of the throat and thereby widen the airway. However, surgical treatment needs to be individualized and it depends on the level of obstruction. Often correction of the nasal passages needs to be performed in addition to correction of the throat passage. Septoplasty and laser turbinate surgery improves the nasal airway. Tonsillectomy and Laser uvulopalatoplasty (LAUP) is available to address pharyngeal obstruction. The patients who have obstruction primarily at the tongue base level are advised to use CPAP machines and follow rigorous exercises and dietary plans to reduce weight since the surgical correction at the tongue base level involves major and more complicated surgical procedures (hyoid bone myotomy and suspension, maxillo-mandibular advancement) which are reserved for few selected patients who have failed all the non-surgical methods, have primarily tongue base obstruction and are moderate to severe OSA patients.
Sleep disordered breathing is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, and accidents. When high blood pressure is caused by OSA, it is distinctive in that, unlike most cases of high blood pressure (i.e., essential hypertension), the readings do not drop significantly when the individual is sleeping. Sleep apnea sufferers also have a 30% higher risk of heart attack or premature death than those unaffected.[13]
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