Surgically patient information for patient’s with sleep apnea

Normally during sleep, air moves in and out of the lungs as the upper airway (throat), chest muscles, and diaphragm move in a coordinated fashion. In a person with sleep apnea, air movement is periodically disrupted or reduced.

Sleep apnea is a serious condition that can affect a person’s ability to safely perform normal daily activities. It is thought that approximately 25 percent of adults are at risk for sleep apnea. Men are more commonly affected than women; other risk factors include middle and older age, being overweight or obese, high blood pressure, and type 2 diabetes mellitus.

The throat is surrounded by muscles that open and close the airway while speaking, swallowing, or breathing. If these throat muscles relax inappropriately during sleep, or if the throat is abnormally small, the airway may be narrowed. This can result in snoring and decreased air flow into and out of the lungs, which is called an obstructive hypopnea. Complete closure of the airway results in cessation of all air movement, and is called an obstructive apnea. A person may have apneas and hypopneas during sleep.

Changes in blood oxygen and carbon dioxide levels occur when breathing is abnormal during sleep. Even if these levels change only slightly, the brain recognizes that there has been an interruption in normal breathing. The brain also recognizes when more work is required to get air into the lungs, as may occur when the throat is completely or partially blocked.

This causes partial awakening (arousal) from sleep. Although the brain may be partially awake, the person may not sense that he or she is awake. When these arousals occur, the throat muscles contract, the airway is reopened and normal breathing resumes. This is often, but not always, associated with a loud snore or snort. The person often goes back to sleep quickly, usually without being aware of the episode. Alternately, some patients with OSAH awaken suddenly and completely with a sensation of gasping, smothering, or choking.

Once sleep resumes, the throat muscles relax, the airway closes, and the pattern repeats itself. This cycle of abnormal breathing, disruption of sleep, resumption of sleep, and recurrence of abnormal breathing can occur many times throughout the night. In this way, OSAH can cause significant sleep disruption and deprivation as well as notable episodes of reduced blood oxygen levels. This is true even if the person is not aware of the frequent interruptions. In addition to poor quality sleep, OSAH may be associated with an increased risk of or worsening of common heart problems.

The main symptoms of OSAH are loud snoring and severe daytime sleepiness. However, some people have no symptoms. For example, if the person does not have a bed partner, he or she may not be aware of the snoring. Sleepiness can also develop gradually over time to the point that the person accepts it as normal.
Other symptoms may include one or more of the following:

• Restless sleep
• Awakening with choking, gasping, or smothering
• Awakening with chest pain or discomfort
• Morning dry mouth or sore throat
• Morning confusion
• Morning headaches
• Personality change
• Memory impairment, difficulty concentrating
• Impotence
• Frequent awakenings to urinate

Surgery is generally reserved for patients who cannot tolerate or do not improve with non-surgical treatments such as CPAP or oral devices. Surgical procedures can reshape structures in the upper airways or surgically reposition the jaw, and may be helpful in some patients. Uvulopalatopharyngoplasty (UPPP) is one of the most commonly performed surgical procedures; it removes the uvula and excessive tissue in the throat, including the tonsils if present. Other surgical techniques include genioglossus advancement, maxillary-mandibular advancement, and radiofrequency ablation (RFA), alone or in combination. In general, it is hard to predict how effective a surgical treatment will be in reducing or eliminating sleep apnea. Thus, such treatments should be considered with caution.

Tracheostomy is a surgical procedure that creates a permanent opening in the neck. It is reserved for patients with severe disease in whom less drastic measures have failed or are inappropriate. Although it is always successful in eliminating sleep apnea, tracheostomy requires significant lifestyle changes and carries some serious risks (eg, infection, bleeding, blockage).

Reference: Up to date in Medicine