What is Snoring?
It means noisy breathing during sleep, on the contrary, OSA means a potentially life threatening condition Who snores?
| At the age of 30 = | 20% of Men |
| 5% of women | |
| At the age of 60 = | 60% of Men |
| 40% of women |
Why incidence of snoring increases with the growing age?
With the growing age Oropharynx and Hypopharynx becomes less elastic and more collapsible.
Why Snoring is more common in obese person?
Obesity precipitate Snoring because weight of Neck increases due to obesity, Fat accumulates in parapharyngeal space that narrows the neck, fullness of base of the Tongue and soft palate.
Snoring and Sleep Apnea go together but not always.
Most persons with sleep Apnea Snor but some do not.
Most persons who snore do not have sleep Apnea, but some do.
Snoring alone can not be used to decide whether a person does or does not have sleep Apnea.
How loud can snoring get?
Noise level is similar to a passing motor cycle.
Can Snoring be Normal in Childern?
No. All Snoring and Apnoea in childern should be considered - Abnormal. But contrary to Adult, their pathology underlying cause is usually found simple like nasal obstruction or nasal allegry, Adenotonsillar hypertrophy.
Adult Snorers are usually obese. While childern are underweight and short in stature.
What is Sleep Apnoea?
It refers to a collection of condition and syndromes e.g.
- Apnoea i.e. [Temporary cessation of breathing during sleep that last 10 seconds or longer]
Pathogenesis of OSA is typicalDuring sleep upper Airway becomes occluded ----> ppt episode of Apnoea ----> brief arousal of sleep ----> breathing returns and pt returns to sleep These sequences are repeated
- Overweight.
- DNS, nasal polyp
- Large Tonsil.
- Retrognathic jaw.
- >Sex : Men (2 to 3 times more)> women. Women start to catch up after reaching to menopause.
- Race? all races.
- Genetic? the risk is higher amongst person who has close relative with OSA.
- Medical Condition : helf of the pt with Heart failure have sleep apnoea.
Types Causes Peripheral OSA Pts with OSA have overcrowded oropharynx (long soft palate, big tonsil & uvula, adenoids, disproportionate upper and lower jaw. Central OSA Airway is not blocked but brain fails to signal the repiratory MS to breath Mixed – Of the 3 types, OSA (peripheral) has received the most attention.
Other sign and symptoms of OSA
- Sleepiness (somnolence) - It may make driving impossible and dangerous. Sleep may overtake a person in the middle of conversation.
Few childern say, they do not like to sleep, as it makes then tired. - Teeth grindings
- Hypertension
- Congestive Ht failure
- Ventricular arrhythmia
- Atrial fibrillation
- Pulmonary HTN
- Automobile accident
- Glaucoma
- Snoring spouse syndome
- Diminished libido
In childern
Hyperactive disorder
Attention deficit
Other associated conditions?
Polycystic Kidney
Renal failure
Hypothyroidism / Diabetes
G E R D
Worsening of epilepsy
What should you look for in a case of suspected OSA?
Complete examination of ENT to discover any obstruction in nose, oropharynx and Hypophanynx, and anatomical abnormalities in upper and lower jaw.
Sleep Study
BP
Blood Suger
Spirometry
Sleep MRI
Management
Medical :
Surgical : remove all obstruction surgically from nose and oropharynx.
| For central SA and Obstruction in Hypophx | Septoplasty / Adenoidectomy Turbinoplasty Tonsillectomy Tracheostomy : Speaking valve |
How to recognize obstruction in Hypopharynx?
By Muller’s manoeuver :
Put a Flexible Fibre Optic Scope in hypopharynx to obtain a view of entire hypopharynx and larynx.
Ask the pt, to pinch the nostril and his or her lips, then attempt to inhale forcefully. If hypopharynx collapses, the test result is positive; means seat of obstruction is below the level of soft palate and the pt will not benefit from uppp alone. Tongue base procedure may be necessary.
CPAP? Yes or No?
No : only when operative treatment is somhow contraindicated.
Why? If given in all cases, as done in many centres running by physician, will give a wrong message to society. People will start beliveing propably CPAP is the only answer to this problem. They will themselves purchase and use CPAP. While his other medical problems will remain unattended.
Surgical removal of obstructions will remove all other associated medical problems of OSA. CPAP application is most inconvenient and not liked by many. They refuse to use it as regular basis and allows other medical problem to grow and complicate the life of sufferer.
Conclusion
You laugh and whole World laughs with you. You Snore and Sleep alone.
