Obstructive sleep apnea is becoming a bigger problem in our society as more and more people are overweight. Patients who have OSA don’t recall waking up at night but usually snore, stop breathing repeatedly throughout the night and wake up tired. The diagnosis is often suspected by family but confirmed per an overnight sleep study which can be done either in the home or in one of two overnight sleep labs in Bellingham depending primarily on your insurance.
Unless one has large tonsils and/or adenoids, therapy focuses initially on nutrition and sleep counseling. Sleeping on one’s side and keeping the head elevated while avoiding alcohol and other sedatives may be helpful while losing a substantial amount of weight is always going to be beneficial in the obese patients. Additional conservative treatment measures include the use of an oral appliance to move the jaw and tongue forward during sleep although these can be difficult to fit and tolerate. Continuous positive airway pressure or CPAP is the most common non-surgical therapy for persistent obstructive sleep apnea. A small portable pump at the bedside sends air through a hose which is held over the nose and/or mouth with a mask. The air pressure widens the airway by pushing the soft tissues aside and is very effective if tolerated.
We often see patient who have failed CPAP and are referred over for a thorough ENT exam to see if they might be candidates for sleep apnea surgery. In addition, patients with obstructing tonsil and adenoid hypertrophy or chronic nasal obstruction/congestion are also referred over for possible sleep apnea surgery prior to a CPAP trial.
Nevertheless, the majority of our patients who qualify for OSA surgery have failed to tolerate the CPAP machine for one reason or another. Ideally, these patients have intact tonsils with a long soft palate and uvula complex which can be removed in a tonsillectomy/uvolatopatalphyringplasty (UPPP procedure). This is a 60 to 90 minute surgery done under general anesthesia. Patients often go home the same day depending on their weight and the severity of their apnea. They will have a sore throat for seven to twelve days and will miss at least one week of work. The large majority of our patients do benefit from surgery although published OSA cure rates nationally are only 50%. Partial glossectomies, geniogloss’s advancement techniques, hyoid suspension, mandibular osteotomies, and tracheostomies are reserved for the morbidly obese patients with severe obstructive sleep apnea who have typically failed the more conservative treatment measures.
Finally, it should be noted nasal airway surgery can also be very helpful in patients who have prominent septal deformities and enlarged turbinates with significant nasal obstructive complaints at night. While not always curative, these procedures often help patients tolerate CPAP and certainly improve quality of life.