Obstructive Sleep Apnea or OSA is a disease which is fast becoming a “Silent Killer” in our country. Actually this is quite a paradox because the patient actually makes a lot of noise when he is snoring. It is termed “Silent” because nobody attributes death directly to OSA as the patient dies due to its consequences which are Increased risk of Heart Attack, Stroke (Brain Attack), Increased Blood Pressure, Diabetes, Thyroid disease, Weight gain etc. the patient might be involved in accidents leading to loss of ones own life but also of others especially if they are drivers or pilots.
OSA occurs as the name suggests due to an obstruction in the path of air entering into the lungs of the patient while he is asleep. The obstruction lies in the nose, the palate or the tongue and more commonly is a mixture of all of the above. As a result the level of oxygen in the blood falls leading to the patient going into a lighter plane of sleep and consequently the body not getting enough rest and oxygen although he might have slept for an adequate number of hours. This can be observed typically by an increasing crescendo of snoring followed by total cessation of breathing for some time and a gasp with which the patient again starts breathing. The patient wakes up groggy and not feeling he has rested in the night or maybe even with headaches and keeps on falling asleep during the day as well. Not only do these patients nod off during meetings but also while driving which can be disastrous.
Snoring is generated by the repeated vibrations of the tissues of the throat and the nose. They can be so loud that it might be impossible for anybody to sleep in the vicinity of the patient making him an object of ridicule, mirth, shame, annoyance and even ostracisation.
These people need help. This is more so for the aforementioned medical disasters waiting for them and not just the social stigma.
Snoring is a progressive disorder; it will only increase with time if no intervention is instituted. One third of people who snore eventually end up having OSA. The attitude regarding snoring in our country is many a time akin to a family heirloom that is passed down the generations. People think it is innocuous but it is not. More so as the table shows there are a lot of other factors which add to this problem, Obesity being a major one. Our populace is becoming more obese due to unhealthy food habits and lack of exercise. Urban Stress and a disordered or decreased sleep time leads to non-restful sleep. Smoking and regular alcohol intake can further complicate matters.
So far the only treatment available for OSA was to breathe through a CPAP machine during sleep, but recently some good results have been seen with some new surgical procedures. They are clubbed together under the name of Multilevel Snoring & Sleep Apnea Surgery. These have been brought about by a greater understanding of the problem and modification of earlier procedures.
The first step though to getting treatment is to get a Sleep study (Polysomnography) done. This test is done while the patients sleeps and tells us of the severity of his OSA.
All patients of OSA should have their ENT examination done, for that reveals the possible sites of obstruction of the airway. They might require a nasal endoscopy and laryngoscopy and maybe even a CT Scan of the nose and sinuses. All patients will benefit with the help of a CPAP machine. It might be necessary to give the patient a CPAP machine as a temporary measure while other treatment modalities become beneficial.
But many patients especially those with obvious nasal problems do not tolerate the CPAP machine well and should be advised them only after the nasal problem has been corrected. Other patients might not like the fact that they have to carry the machine wherever they go especially those with a traveling job. Still others might find the machine claustrophobic.
Till now these patients had no other option. We have recently operated on a series of patients who have had good relief from their snoring and OSA. Some of them have even been taken off their CPAP machines. We carry out carefully selected procedures on the nose, palate and tongue which free the airway from obstruction as a one time surgery. There are various procedures present and their combination depends on the individual anatomical structure of the patient. The crux is the one carried out on the tongue as it falls back into the airway while the patient sleeps most of the times.
As the OSA improves the various medical risks associated with it are also reversed and the patient is alert during the day and his quality of life improves. To maintain the benefits of the operation it is necessary that the patient brings about lifestyle modifications like quitting smoking if he does and make sure that the weight does not increase. Those patients who are very overweight are in fact not good candidates for this surgery and should initially lose weight by dietary modifications or in case of morbidly obese undergo Bariatric surgery before opting for the Multi-level Snoring & Sleep Apnea Surgery.
Once the patient sleeps better he feels more motivated to exercise and lose weight, otherwise the lassitude and fatigue do not let the patient exercise and he remains in the vortex of a vicious cycle.
With this technique we are hoping to bring succour to lots of patients who have not had a good nights sleep themselves and also to their partners.
FACTORS CONTRIBUTING TO SNORING & OSA
Deviated Nasal Septum
Nasal Allergy & Sinusitis
Less Sleep Time
Loss of General Muscle Tone
Thick & Long Soft Palate