Snoring and Obstructive Sleep Apnea Surgery

What is sleep apnea?

Sleep apnea is a condition characterized by periods of reduced airflow or complete blockage in the upper airways during sleep, resulting in episodes of interrupted breathing (apnea) along with snoring. During apnea episodes, oxygen levels in the body’s tissues decrease. Many systems in the body, including the cardiovascular system, are affected by sleep apnea.

What are the consequences of sleep apnea?

The risk of experiencing palpitations, hypertension, and heart failure significantly increases. Patients with sleep apnea often wake up feeling tired and may experience morning headaches. Excessive daytime sleepiness, momentary lapses of sleep leading to accidents at home, work, or while driving, are also common. Personality and behavior changes such as decreased decision-making ability, forgetfulness, irritability, and depression may occur. Urogenital problems such as decreased sexual desire and performance and nocturia (frequent nighttime urination) can also be seen.

Under what circumstances is sleep apnea observed?

Common causes of obstructive sleep apnea include sagging of the soft palate and an enlarged uvula, significantly enlarged tonsils, an enlarged tongue, and the backward movement of the tongue. In children, enlarged adenoids and tonsils are the most common causes. Structural abnormalities in the skull and facial bones can also, although less frequently, lead to sleep apnea.

Other risk factors for obstructive sleep apnea, apart from anatomical factors, include overweight and obesity, smoking, alcohol consumption, advanced age, genetic factors, male gender, and the use of certain medications that increase the tendency to sleep.

How is sleep apnea diagnosed?

A detailed medical history is taken from the patient and their close ones. Following this, a thorough ear, nose, and throat examination is performed. To confirm the diagnosis of sleep apnea, a sleep test (polysomnography) is conducted, which is considered the gold standard. During this test, various parameters are monitored and recorded, including heart rate, oxygen levels, brain waves, eye movements, muscle tension, and chest wall activity. These recordings are used to determine whether the patient has sleep apnea and, if so, the severity of the condition.

What is sleep endoscopy?

At Acıbadem Taksim Hospital’s Ear, Nose, and Throat Clinic, we approach sleep disorders and sleep apnea surgery with special attention and scientific methods. Before recommending surgery to patients, we perform sleep endoscopy for diagnostic purposes. Sleep endoscopy is a method that provides a solution for finding the source of upper airway problems. It is a relatively new technique used worldwide. We create an environment as close to normal sleep as possible under anesthesia, administer medications to induce sleep, and then examine the entire upper respiratory tract with a camera. Based on the findings, we recommend treatment options tailored to the specific site and degree of obstruction. This method helps improve the effectiveness of surgery by targeting the precise location of the obstruction.

How is sleep apnea treated?

There is no single definitive treatment for sleep apnea. Treatment is carried out by considering various factors. Weight loss, restrictions on smoking and alcohol consumption, and reducing medications that can exacerbate sleep apnea are the initial steps. Various non-surgical treatments are available. Continuous positive airway pressure (CPAP) machines, which provide constant positive air pressure to prevent sudden narrowing and closure of the upper airways during sleep, are frequently used and can yield good results. In some cases, mouth appliances that advance the soft palate and tongue, widening the airway during sleep, can be provided. While CPAP therapy can be highly effective, patient compliance can be challenging. Some patients find it uncomfortable to use the device every night, reducing treatment adherence. In such cases, surgical options may be considered.

Under what circumstances is surgery recommended? What types of surgery are performed?

The level of obstruction in the upper airways is determined during sleep endoscopy. There are numerous surgical options available to expand the upper airways for patients with sleep apnea. Nasal surgeries are among the most commonly performed procedures. Nasal surgeries are highly effective in patients with snoring and mild sleep apnea. They can also alleviate symptoms in patients with moderate to severe sleep apnea. Procedures such as uvulopalatopharyngoplasty (UPPP), tonsillectomy, modifications to the throat region, and reduction of the tongue and its base are among the most commonly performed surgeries for sleep apnea. Surgical procedures on the facial bones are rarely performed. In children, the most common surgeries are adenoid and tonsillectomy procedures.

What are common problems following sleep apnea surgery?

Following sleep apnea surgery, there may be pain and, rarely, a risk of bleeding. Early postoperative bleeding and late postoperative bleeding, occurring around the 7th day, can be observed. The use of advanced technology during surgery and surgical techniques can reduce the risk of early pain and bleeding. Additionally, compliance with medication and dietary guidelines can significantly decrease the risk of late pain and bleeding.

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