Snoring implies incomplete obstruction of the upper airway. Obstructive sleep apnea (OSA): Cessation of breathing during sleep because of mechanical obstruction, such as a partially collapsed trachea, retropositioning of the tongue in the airway, which blocks airway passage, or a large amount of tissue in the upper airway.
DON’T DISMISS SNORING AS “NATURAL”
Often, snoring can be dismissed as a natural part of aging. While it’s true that snoring can increase over time with age and weight gain, it should not be accepted as an ordinary and standard juncture in life. Remember, there is a solution to this problem.
Patients with obstructive sleep apnea syndrome (OSAS) have reduced airway patency caused by a reduction in airway size and a decrease in pharyngeal dilator tone. The risk of developing OSA among obese children is four or five times that of normal-weight children.
UPPER AIRWAY PATENT MECHANISM
UPPER airway patency is essential for normal respiratory function. The maintenance of a patent airway is dependent on the pharyngeal and laryngeal structures. However, there is a certain phase of pause in their function like talking, speaking, eating. This acts as a protective mechanism.
The morphologic structure of the upper airway is important in the maintenance of the patent airway during sleep and wakefulness. The nasal passage has a bony architecture with the cartilaginous larynx and extrathoracic trachea, which helps produce a conduit for inspiration and expiration of air during sleep and wakeful state.
However, in some people obstruction occurs during sleep.
The degree and extent of the obstruction and the ensuing clinical state is variable but critically dependent on the dilator muscles of the pharynx.
RISK FACTORS
Most patients arrive to the doctor complaining of snoring, daytime sleepiness, poor sleep patterns, or complaints from their partners. Unlike other medical disorders that are easily recognizable by patients, this illness only affects them in sleep and patients are unaware of its presence.
- ANATOMIC FACTOR
- Retropositioning of tongue
- Maxilla-mandibular retrognathism
- Receded chin
- Inferiorly positioned hyoid bone
- Tonsillar hypertrophy-Deviated septum
- Nasal polyp
- Enlarged nasal turbinates
- The fatty deposits in the neck
- Elongation of the uvula and soft palat
- OBESITY
- AGING
- PREGNANCY AND MENOPAUSE
- NASAL CONGESTION
- ALCOHOL AND SMOKING
- FAMILIAL PRE-DISPOSITION
Noticeable features of sleep Apnoea
- A chronic history of loud snoring,
- Daytime fatigue,
- Daytime sleepiness,
- Morning/awakening headaches,
- Poor memory,breathless awakenings, limb jerkiness
- Witnessed sleep disruption events
- Gasping and shortness of breath
- Labored noisy breathing.
Up to 50% of patients who have sleep apnea have high blood pressure, and there is a direct correlation between this disease entity and heart attack, stroke, and cardiovascular disease. Snoring and obstructive sleep apnea can be eliminated or controlled in many of these patients by the use of oral appliances.
SURGICAL TREATMENT OF SLEEP APNEA
Surgery aims to alleviate anatomic sites of obstruction in the naso-, oro-, and hypopharynx. In adults, surgical options include:
- Surgeries occurring in 2 phases, first that of Nose, Palate, tongue and second of maxilla and mandible.
- Distraction osteogenesis of the maxilla and mandible, and finally, tracheotomy.
- In children, tonsillectomy and adenoidectomy (TNA) represent the major surgical intervention
- Adjunctive treatment in children includes maxillary and mandibular distraction via orthodontics.
- LASER assisted uvulopalatoplasty
SELF-HELP STRATEGIES TO STOP SNORING
Change Your Sleeping Routine One of the easiest ways to eliminate snoring is to make some simple changes to your regular pre-bed routine. We’re going to go over some of the best options when it comes to improving your sleep hygiene for peace and quiet in the bedroom.
Elevating your head is one of the fastest ways to stop snoring. Lifting your head by about four inches as you sleep can ease your breathing and encourage your tongue to rest in the best position to prevent snoring.
Try an anti-snoring mouth guard if you’re an open-mouth snorer. These devices are designed to keep your airway open as you sleep by aligning your lower jaw.
Flush your nasal passages to prevent inflamed sinuses or a stuffy nose causing you to snore.
Make Lifestyle Changes- If you’ve tried making changes to your bedtime routine and still find yourself snoring the night away, your next step is to make some of the following tweaks to your lifestyle to see if that improves the situation and keeps your sleep peaceful.
Losing weight can dramatically cut back on the likelihood of snoring, even if it’s just a few pounds of fatty tissue, as it reduces the pressure on the throat as you sleep.
Giving up cigarettes reduces irritation to the membranes in your throat and nose, eliminating a common cause of snoring due to inflamed airways.
Cutting back on alcohol or sedatives will also reduce the chance of snoring. It will relax your throat muscles.
Eating with sleep in mind- Make sure to eat lighter meals before bedtime and avoid dairy at least two hours before bed to help prevent a thickening in the throat membranes, which can lead to snoring.
REFERENCES
- Madani, Oral Maxillofacial Surg Clin N Am 21 (2009) 369–375
- Madani, F. Madani Atlas Oral Maxillofacial Surg Clin N Am 15 (2007) 69–80
