4-Snoring and Obstructive sleep apnea
Snoring is a worrying symptom and it usually bothers the bed partner, snoring may affect adults or children, men more than women.It is a usually aggrevated with obesity.
Snoring is usually accompanied by stoppage of breathing for a while then the patient resumes breathing and stoppage again and so on.
Snoring patient usually wakes up tired and complaining of headache and tendency to sleep in nearly all situation even while driving or working which reduces the efficiency of work and expose the patient to serious accidents. Snoring patient if left untreated is prone to cardiac and hypertensive problems.
Snoring is caused by vibration of the soft palate and the uvula while the patient tends to breath vigorously to compensate the lack of oxygen.
The proportionality between the weight of the patient and (his/her consumption of oxygen) and the breathing passages (through the nose, mouth and the pharynx) are the insurance of normal quiet sleep. In cases of obesity there is need for more oxygen so the patient needs to breathe more air and this happens by day and night but at night the redundancy of the pharyngeal muscles has the main role in causing snoring.
And in cases of nasal obstruction (nasal polyps, deviated septum, mucosal redundancy) or pharyngeal obstruction (redundancy of the soft palate, uvula or tonsillar hypertrophy) narrowing of the airway encountered so the amount of oxygen decreases and that urges the patient to breathe more air and in these cases snoring followed by cessation of breathing as a result of complete obstruction which leads to decrease of oxygen and increase of carbon dioxide levels in the blood and in this critical moment patient wakes up to alert the brain and to resume the muscular movement of the pharynx once more and this cycle is repeated during sleep.
As for diagnosing of a case of snoring proper history taking from the patient and from the bed partner, weight and height of the patient. Endoscopy of the nasal passages to detect the site and the degree of obstruction in the nose, pharynx or the tongue.
In addition making doing a sleep laboratory to detect the degree of snoring, the sleep apnea, the degree of concentration of the oxygen, the heart rate and patient’s position during sleep.
It is worth mentioning that the device of the sleep laboratory is now available in small and practical size made it easy to perform that investigation during the usual sleep of the patient at his/her own home and the device is taken in the next morning to collect the data taken over night using the computer.
Planning for the treatment of snoring and sleep apnea patient starts by weight reduction, sport practicing, and prevention of sleep on the back, prevention of tranquilizers or antihistamines, and the advice of drinking a cup of tea, coffee or cola before sleep.
In cases of nasal obstruction ,computed tomography is recommended to detect the distribution of nasal polyps, deviated septum and management of this cases is done by using the endoscopy and the shaver.
In cases of redundancy of the soft palate and hypertrophy of the uvula, reconstructive surgery is done to the soft palate, inversion of the uvula and tonsillectomy to get a wide airway passage.
In severe cases of sleep apnea and severe obesity, operative work up is very difficult and usage of a small device called CPAP is applied to the nose during sleep to guarantee the continuous opening of the airway and this device is mandatory to prevent serious complications and suffocation during sleep.