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Snoring + OSAS
Dave Pothier
St Michael’s Hospital
2004
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Definition
Snoring is noisy breathing during sleep
OSAS is upper airway obstruction during sleep
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What is it?
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Who snores?
Men Women
Age 30 20% 5%
Age 60 60% 40%
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How loud?
• Kära Walkert from Sweden:
93dB recorded at Örebo Hospital,
24 May 1993
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Morbidity
• None to patient…
• Many reports of shootings and GBH from partners of snorers
• Surgery almost entirely done for another’s benefit
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Who?
Who snores:Facial abnormalitiesMicrognathiaOverweight, thick neck, heavy drinkersAdenoids
Who has OSAS:Snorers (end of spectrum)5% of population25% of hypertensives50% of OSAS sufferers are hypertensive
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So…NB to differentiate
History
Examination ???
Investigations
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Pickwickian syndrome
‘Fat Boy’
Famous for daytime somnolence
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Hx
• Weight• Alcohol• Smoking• Nasal symptoms
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Epworth score
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Examination
• Nose
• Nasendoscopy
• +/- Muller manoeuvre
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Investigations
• Sleep nasendoscopy
• Sleep studies
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Treatment of snoring
• Conservative
• Medical
• Surgical
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Treatment
• Conservative
Stop all fun things in life- eating lots- drinking lots of beer- smoking
VERY EFFECTIVE IN MOST CASES
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Treatment
• Medical
- over the counter sprays
- homeopathy?• Mandibular splints
Not good!
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Treatment
• Surgical
OSAS – largely contraindicated
Snoring – a myriad of operations
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Surgical options for snoring
• Nasal
• Palatal
• Tongue base
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Nasal surgery
• Septoplasty
• SMR
• IT’s
• Adenoids/tonsils
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Tongue base surgery- not commonly perofmed
• Advancement procedures
• Partial glossectomy
• Maxillomandibular advancement
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Palatal surgery 1
• Ensure all other causes eliminated
• Exclude OSAS
• Exclude nasal pathology
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Palatal surgery 2
-LAUP -UPPP
-Coblation et al
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Effectiveness
• 80% immediate effect after recovery
• 30% at two years
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OSAS
• Medically treated with CPAP(almost 100%
effective)
(only 50% compliance)