09 Oct Is sleep apnea destiny?

Sleep is defined as a state of unonsiousnesss in which a sleeping person can awake sensory or other stimuli, constitutes about 1/3 of human life. Sleeping disorder is important because it decreases the quality of life. Sleeping problems comes across many times in illnesses as a complaint. In recent years, more attention has been drawn to sleep and sleep related disorders.

When the air flow in the respiratory system is interrupted for at least 10 seconds, the character is called apnea. Sleep apnea is the most common cause of sleep disturbance in patients with obstructive sleep apnea syndrome (OSAS) characterized by recurrent breathless episodes of upper respiratory tract, oxygen desaturation and awakening periods.

Obstructive sleep apnea has been diagnosed by Guilleminault and his friends in 1976. The reason for OSAS is anatomic factors in airway and muscle power loss in the upper airways are the main factors. Identification of the anatomical regions that lead to obstruction is also necessary for the development and selection of appropriate treatments.

Various factors related to the development of OSAS are influential. These are gender (mostly in men), age (increases in later ages), obesity, alcohol and drug medicines, genetic factors, person’s anatomic characters (nose, throat structure), sleep positions, neurologic factors can be effective.

There are various diseases that can be associated with and cause sleep apnea. For the purpose of disgnosing sleep apnea, detailed radiography and magnetic resonance (MR) examinations, respiratory function tests can be done wih some x-ray examinations, and polysomnography examination of the sleep apnea.

Anxious divided sleep, snoring out loud, diagnoses apnea, waking up chocking or asphyxia attacks, having severe daily dormancy, daily tiredness, worsen in intellectual ability and decrease in concentration, dyspepsy and gastroesophageal reflux, memory loss, wake-up threshold fall, depression, psychological problem, headaches during day time, change in character, decrease in libido and disoruder in sexual functions, mouth dryness, sweating at nights, enuresis (peeing at nights) or frequent urination at nights such compalints can be seen in sleep apnea. In addition, many sleep apneas can be caused by examination alone. It is important in sleep apnea to do detailed ear nose throat, chest diseases and neurologic examination.

There are many treatment methods recommended for OSAS with discussions on activities. The most known effective and gold standard treatment is CPAP (Nasal continuous positive airway pressure). Besides this, various medicine and oral devices have been tried and the efficacy is not clear. Changing life styles can be effective as well, the most important ones are quiting smoking and losing weight.

When we look at surgical treatments, many surgical methods have been defined and applied daily from the past. The size of the surgeon is regulated by patient motivation, severity of complaints, severity of disease determined by polysomnography, and location and severity of upper respiratory tract collapse. Patients should be eligible for medical and psychological surgical intervention. Surgical treatment options can be listed as follows.

Nasal surgery
Nasal septoplasty
Inferioe concha resection
Adenoidectomy
Nasal timor or polyp excision
Nasal walv reconstruction

Palatal surgery
Uvulopalatopharyngoplasty
Uvulopalatal flap
Anterior palatoplasty
Z-palatoplasty
Lateral pharyngoplasty
Injection snoroplasty
Tonsillectomy
Transplatal improvement pharyngoplasty
Laser-assist uuvulopalatoplasty
Palatal radiofrekans

Hypofaringeal surgery
Hyoid myotomy and suspantion
Tongue base radiofrekans
Partial glossectomy
Lingual tonsillectomy
Repose tongue suspension

Laringeal surgery
Epiglottidectomy

Maxillofacial surgery
Maxillomandibular osteotomy and improvement
Mandibular osteotomy with genioglossus improvement

Tracheal surgery
Tracheotomy

When these surgeons’ activities are assessed one by one, different outcomes have been observed, but the new vision accepted by the whole world is the multilevel surgeon. In short, the nose, palate and tongue root surgeons are co-applied. This can be done in one operation or in different operations.

Our suggestion is in patients who can detect the problem, it is primarily surgery for probing. Primarily nose is important. Because the nose is the first point of breathing and it is normal to breathe through the nose. If there is a problem in the nose firstly fixing the problem there and if the complaints do not get better, palate and tongue root operations as a means of adding significant benefit to our practice.

I think that it is very beneficial to make special evaluations and applications for the patients in terms of effective and adequate treatment in our patients. Of course, sleep apnea is not destiny and that the quality of life of a person is seriously improved with effective treatment.