Snoring and Apnea
SNORING IN CHILDREN AND ADULTS FROM THE POINT OF VIEW OTOLARYNGOLOGIST.
Surgical treatment of snoring.
Snoring has been until recently cause for jokes, jokes and, above all, a nuisance to those who should bear the snorer / a. But when it was discovered that snoring not as harmless and can hide a pathology considered one of the issues most important public health, ceased to be mocked. The disease to which we refer is obstructive sleep apnea, a syndrome that is due to the occurrence, during sleep, intermittent and recurrent episodes of occlusion of the upper airways. Apnea is highly prevalent among the adult population: between 4-6% of men and 2% of women with this syndrome. It is estimated that in Spain there are between 1.5 and 2 million people affected. During sleep the muscles are very relaxed and lost, in part, motor coordination that normally exists between the respiratory muscles, especially between the diaphragm and the throat. With this, the top of the pharynx collapses, as it is the only section of the airways that does not have a cartilaginous structure to prevent collapse. When this occurs, your breathing stops for a few seconds. All people suffer from sleep apnea episodes of very short duration of 2-3 seconds. Now, when there are violent snoring, loud and apnea lasting longer than 10 seconds, we are likely to Saos syndrome (Saos). Snoring is caused by the vibration caused by the passage of air in the soft parts of a narrowed airway and is the most common symptom in those affected by this disease. However, not all snorers have sleep apnea. Snoring is observed in 10-30% of women and up to 50-60% of men, but only 5-10% of these cases are associated with Saos.
What are the factors predisposing to Saos in adults? If we try correct an Saos snoring can be curbed?.
During apnea breathing stops. The blood does not get oxygen desaturation and it will, so that the respiratory muscles increase thoracic and abdominal movements to overcome the obstruction. The apnea end with a stertorous snoring accompanied Movers and Shakers, causing an arousal after which the process is restarted. These arousals destructure sleep, which becomes irregular and fragmented, and prevent deep, restful night's sleep. Over time the blood oxygen desaturation (hypoxemia) and embrace greater concentration of carbon dioxide (hypercapnia). As a result of these changes appears excessive daytime sleepiness: the victims were sleeping in any circumstance causing traffic and occupational accidents. Poor performance at work, intellectual impairment, memory loss, behavioral disorders, depression, irritability ... are just some of the consequences of apnea. But in addition, are common among the affected arterial hypertension and ischemic heart disease, still high risk of sudden death by arrhythmia.
What causes apnea consequences? Is it true that it has been shown to be related to sudden death and hitertensión
Normally the person living with the affected is the first to detect this pathology. Nighttime symptoms are snoring, pauses prolonged apnea, sudden awakenings with feeling of suffocation or restless sleep. The daytime excessive sleepiness, irritability, anxiety, depression, intellectual deterioration, loss of libido, morning headaches. When there is an association of several symptoms listed, especially at night, we must suspect that it is Saos and should seek medical advice. Most of the causes of snoring can be identified in an ENT consultation. The definitive diagnosis is made on a unit by a study pulmonology nighttime breathing, which simultaneously records neurophysiological and cardiorespiratory variables.
Who first diagnosed this condition? Definitive diagnosis?
Once the patient is aware of the problem we proceed to assess the cause and ENT examination is requested. All of this disease because the majority due to obstructive problems improve when the patient loses weight, changes the regimen of life, exercise, eat healthy and try to lift the headboard of the bed 30 degrees. Only when these measures fail dietary toilet is offered to patients with Saos treated with CPAP and those who do not tolerate CPAP or the cause of obstruction is located by ENT surgical treatment.
Snoring surgery is a procedure built into the field of otolaryngology relatively recently. The frequency of snoring and its importance, especially family, make it a serious problem.
Is snoring surgery is useful in all snoring patients?
The effectiveness of surgical procedures used for the treatment of snoring, whether we speak of a simple snoring as if we speak of a patient with sleep apnea syndrome (SaosS), depends on the ability to pinpoint anatomical sites responsible for the obstruction and snoring, and the possibility to correct surgically.
Unfortunately it is not always possible to locate the area responsible, not all problems can be solved effectively with surgery. Therefore, surgery is not useful in all patients, and it is therefore necessary that the otolaryngologist determines in advance which patients may be useful in various surgical procedures, and what procedure will be most suitable for each person. When you perform a good study of the patient and an appropriate selection, surgery reduces snoring in more than 75% of cases, sleep apnea and a smaller percentage.
What is the specialist can best advise?
Snoring, with or without sleep apnea, is caused by an obstruction and vibration of parts of the upper airway. Your doctor can best evaluate the pharynx, oral cavity and the nasal is, without doubt, the otolaryngologist, and is therefore the study should direct the patient's communication with other specialists that might be needed for proper diagnosis: pulmonologists, neumofisiólogos, cardiologists, endrocrinólogos, radiologists, etc..
What operations are available to treat snoring?
Most common operations to treat snoring are:
- Uvulopalatopharyngoplasty or partial resection of the soft palate.
- Uvulopalatoplasty (LAUP, Laser Assisted Uvula-Palatoplasty).
- Radiofrequency surgical treatment.
- Tonsillectomy with / without adenoidectomy (removal of vegetation).
- Surgery nasal septal deviation, nasal polyps, and so on.
- Palate implant surgery.
- Tracheostomy .
What is radiofrequency surgery?
Surgery Radiofrequency is a procedure that uses radiofrequency energy to treat the area of the palate and uvula. This operation can be performed in a medical office or operating room under local anesthesia and usually takes less than half an hour. It does not require hospitalization.
Treated tissue is heated with radiofrequency enough to create a zone of coagulation. Over the next four to six weeks the treated tissue disappears naturally, thereby reducing the volume and strengthening the area responsible for snoring. Following this procedure, you may see swelling or discomfort during the following days, as if it were a cold. During the next month and should experience a noticeable improvement in snoring. Depending on the level of snoring may be necessary to repeat the procedure. This procedure can be labeled painless and allows rapid recovery.
What are the advantages of radiofrequency surgery?
This procedure can be done in consultation with local anesthesia. No need for hospitalization.
Little painful procedure, unlike other techniques.
Patient's recovery is very fast.
Repeating the procedure easy.
Complications are rare, making it a very safe procedure. On the contrary, more often have to repeat the procedure over time to eliminate snoring.
What is the treatment of palatal implants?
This is the introduction of 3 small biocompatible implants in the soft palate in order to give strength and rigidity to prevent vibration and collapsibility.
What are the postoperative care of snoring surgery?
After a radiofrequency surgical treatment or care palate implants are minimal because with these techniques the patient will have pain and not just present a scar area as extensive as with other procedures.
Normal diet can be reintroduced quickly and painkillers are almost necessary. Recovery occurs within a few days.
What complications can have surgery for snoring?
You may feel that the mucus running from the nose to the mouth, dry throat, vague discomfort in the throat. These annoyances are offset over time. Also, if there has been an excessive removal of tissue can produce a regurgitation of liquids with swallowing or food from the mouth to the nose, and conversely, if there has been insufficient excision of tissue, snoring may persist . Another very rare complication is the creation of a narrowing in the treated area which may require surgical procedures to repair it.
The radiofrequency or surgical treatment of palatal implants, complications do not actually exist, but more often the need to repeat the procedure had not caused the desired effect.
Is it always the soft palate for snoring responsible?
No, there are anatomical areas as the base of tongue, pharynx, or the turbinates that facilitate or worsen snoring and may be tax surgical treatment.
Can associate other surgical procedures for snoring surgery Radiofrequency?
Yes,in selected cases can be performed uvulectomy or section of the uvula to reduce the component tissue and vibrator.
Can Saos children has the condition?
Is a little known entity with a high prevalence among children according to some surveys, is between 1 and 3%. 10% of children between 4 and 6 years are becoming more frequent snorers between 3 and 5 years with the maximum size of lymphoid organs.
When can you say that a child has Saos?
Adult and difference with the 10-second pause of apnea in children even some authors consider the presence of a pathological episode of obstructive apnea per hour of sleep or the existence of more than three desaturations per hour of sleep .
What causes obstructive sleep apnea in children?
The first and fundamental
adenotonsillar hypertrophy, other less frequent malformations, gastroesophageal reflux, obesity, Laryngomalacia, neurological diseases.
What is the diagnostic method?
What are the symptoms of Saos in children?
Most children go alone with nighttime snoring (snoring primary). Only those who have Saos have prolonged periods of partial obstruction of the upper airway associated with hypoxia, hypercapnia, or sleep. The symptoms would be increased respiratory effort, restless sleep, sweating, high mobility at night, strange postures, nocturnal enuresis.
Complicity and consequences of Saos in children?
Decreased school performance, behavior problems, daytime sleepiness, systemic hypertension, heart failure, psychomotor retardation, growth failure cor pulmonalee
Adenotonsillectomy and radiofrequency turbinate
Childhood Saos is a frequent serious and often undiagnosed. Diagnosis is made by polysomnography be invaluable, and other methods such as records or pulxiosimetria cardiorespiratory night when done properly. Adenotonsillectomy continues to maintain a role in their treatment. Nasal CPAP is effective and well tolerated in children who do not respond to surgery or those with craniofacial abnormalities. In selected cases the administration of supplemental oxygen may be helpful.
Snoring in adults can be treated initially by changing the regimen of life and acquiring healthy habits. If that does not respond to these changes may offer a surgical treatment currently being RF and palate implants the most painless and can be repeated if they have not improved sufficiently. In the case of a patient with Saos the treatment of choice is CPAP and only in circumstances where the cause of the obstruction is located at ENT and surgical treatment is subject to recommend the surgical option.
IF YOU NOT BREATHING WELL FOR YOUR NOSE HAVE A HEALTH PROBLEM THAT CAN RESULT IN SERIOUS LONG-TERM CONSEQUENCES AS OBSTRUCTIVE SLEEP APNEA AND REPEAT sinusitis.
IF YOU SNORING, NOT A JOKE, IT IS A HEALTH PROBLEM. THE EVOLUTION snoring patients LONG MAY RESULT IN A SYNDROME OBSTRUCTIVE SLEEP APNEA.
SYNDROME Sleep Apnea IS ASSOCIATED WITH INCREASED ARTERIAL HYPERTENSION INDEX , stroke and heart disease.
THE BEST WAY TO CURE A syndrome of obstructive sleep APNEA THROUGH PREVENTION NOT LEAVE IF NOT BREATHING WELL snore or through your nose.
Today there MINIMALLY INVASIVE TREATMENTS UTPATIENT WITHOUT COMPLICATIONS THAT MAY SIMPLY SOLVING YOUR PROBLEMS (IMPLANT OF PALATE, RADIO ..)