Snoring and Sleep Disorders
Adult Obstructive Sleep ApneaOSA can affect people of any age, but the prevalence increases between middle and older age. Common symptoms include heavy snoring with witnessed pauses, gasping, or snorting during sleep, and excessive daytime sleepiness. About 80-90% of adult with OSA remain undiagnosed. Risk factors for adult OSA include obesity, large neck size, male gender, and being middle aged or older. If left untreated, OSA can result in chronic hypertension, increased risk of stroke, heart attack, and arrhythmia, diabetes, poor concentration, mood disturbance, and increased risk of deadly motor vehicle accidents. OSA can also have significant impacts on the quality of life for bed partners of those afflicted as well.
Risk Factors for Adult OSA:
- Overweight (Body Mass Index 25-29.9) or Obesity (Body Mass Index >30)
- Large neck size (>17 inches for men, >16 inches for women)
- Middle age or older, post-menopausal
- Craniofacial anomalies
- Down syndrome
Treatment of Adult OSA
- Positive Airway Pressure (PAP) therapy –first-line treatment
- Oral appliance therapy –alternative to PAP for those who fail or are unable to tolerate PAP therapy. Most effective for pts who are non-obese with mild-moderate OSA
- Surgery –alternative to PAP for those who fail or are unable to tolerate PAP therapy. A wide variety of surgical options have been developed targeting specific anatomic features that may be contributing to obstruction (see below).
To make an appointment for initial diagnosis of OSA, please contact the Sleep Disorders Program at 503 494-6066.
Surgery for OSA
Obstruction can occur throughout the upper airway, and multilevel obstruction is common. The parts of the upper airway most commonly contributing to OSA in adults are the nasal airway, the soft palate, and the back of the tongue. If the tonsils are present and large, these can also contribute to obstruction. Various surgical procedures have been developed over the years to target each of these areas. Surgery must be tailored to each patient's specific anatomy, and not every procedure or intervention will be appropriate for every patient.
Drug-Induced Sleep Endoscopy (DISE)To help determine the optimal surgical approach, a common part of the evaluation process is a diagnostic procedure called drug-induced sleep endoscopy (DISE). In this procedure, the patient is placed under a sedated sleep, then a flexible fiberoptic endoscope is passed through the nose to the back of the throat to visualize the areas are collapsing and causing snoring and obstruction. Based on this evaluation, further surgery can be planned targeting the problem areas.
Specific ProceduresThe following list of procedures are commonly performed for OSA. This is not a comprehensive list, and other interventions may be recommended or performed if deemed appropriate.
- Bilateral inferior turbinate reduction
- Endoscopic sinus surgery
Soft Palate/Pharyngeal Procedures
- Uvulopalatopharyngoplasty (UPPP
- Expansion pharyngoplasty
- Radiofrequency ablation of the soft palate
Base of Tongue Procedures
- Lingual tonsillectomy
- Posterior midline glossectomy
- Genioglossus suspension
- Radiofrequency ablation of the tongue base
- Transoral robotic surgery of the tongue base
Bony Skeleton Procedures
- Maxillomandibular advancement
- Mandibular distraction
- Sliding genioplasty
Upper Airway Stimulation
- Inspire Hypoglossal Nerve Stimulator (see below for further details)