Long considered a sign of good quality sleep, snoring is now recognized as one of the key symptoms of a potentially serious condition: the sleep apnea syndrome (SAS).
In order to obtain the best treatment for sleep apnea a unique and personalized approach is necessary.
One in four adults snore regularly which is a common reason for visiting an ear, nose and throat specialist.
2% of women and 4% of men suffer from sleep apnea.
These two problems have the same origin: The snoring comes from a narrowing of the airways with vibration of the soft tissue (uvula, soft palate) and a reduction of the oral respiratory flow and for the SAS, the phararyngeal mechanism of decreased flow becomes a complete obstruction of the upper airway for between 10 seconds and 2 minutes.
The short and medium term consequences of sleep apnea are tiredness on waking, daytime sleepiness, an increased risk of hypertension and cardiovascular problems. All these conditions disappear following effective treatment of SAS.
Morning headaches, a feeling of having had unrefreshing sleep, daytime sleepiness (assessed using the Epforth questionnaire), high blood pressure are suggestive signs of SAS.
Alcohol consumption and taking sleeping pills are aggravating factors which can cause snoring.
Conjugal problems are often caused by snoring and are sometimes the only reason for consulting the specialist.
Did you know?
Scientists estimate that patients not treated for sleep apnea have:-
2.8 times greater risk of a fatal cardiovascular attack
2.4 times increased risk of a stroke
2.9 times increased risk of hypertension
A swiss study has shown that untreated sleep apnea increased the risk of having a car accident by 15.
STUDY OF SNORING AND APNEA.
It is a simple examination that records the patient's sleep at home.
Using multiple sensors (nasal prongs, oximetry, chest and abdominal movements, body position allows the doctor to quantify the intensity of snoring during sleep, positional character or not, the amounts of sleep apnea each hour, oxygen saturation of the blood, pulse changes and micro awakenings.
At the end of the examination the patient is:
Either:- simple snorer without apnea
or snorer with moderate apnea
or snorer with severe apnea. This is sleep apnea syndrome.
In all cases there are dietary hygiene and lifestyle rules.
If the patient is seriously overweight a diet is necessary. Reduce tobacco consumption.
Avoid alcohol and sleeping pills at night.
It is performed under general anesthetic and involves removing the uvula, part of the soft palate and tonsils if they are obstructive.It may be necessary to reduce nasal obstruction also.
The after effects are quite painful and there is a risk of bleeding. The patient will be off work for a week.
There is a 75% success rate in the reduction of snoring.
Results for the SAS are inconsistant and uncertain.
Radio frequency of the soft palate is an operation that lasts 30 minutes and is performed under local anesthetic. An electrode is planted in different parts of the soft palate to send an electric current with an precise wavelength so vibrations on the palate are reduced as is the volume. There is no pain afterwards.Only 1 oedeme level of the uvula may interfere with swallowing and corticosteroids should be prescribed.
Doing it this way means no time off work.As far as snoring is concerned 50 % of patients are satisfied.
This technique is not recommended for the treatment of apnea.
Under local anesthetic it gives the same results as radio frequency but is more painful.
Mandular advancement device. (OAM).
This enables one to keep the lower part of the jaw in a forward position during sleep thus reducing the problem of obstruction.The orthosis can be performed in the doctor's office or can be made, ready to use, by the chemist.The results are excellent and snoring subjectively and objectively reduced or stops completely. Apnea is significantly reduced.
The OAM is easy to carry out. Impressions of the two arches are necessary as is the recording of data and information concerning the static and dynamic occlusion.
Using the impressions several laboratories are making these ortheses.
There are certain limits as far as bucco-dental is concerned due to the absence of foundation points to attach OAM grooves; uncompensated toothless spaces, insufficient number of teeth on the arch, severe unstabilized periodontitis resulting in loss of foundation points.
The pathologies of ATM need to be evaluated and treated if necessary. Similarly, poor oral hygiene and its consequences, (tooth decay, gingival inflammation) can, in severe cases, be a temporary contreindication.
Continuous positive nasal airway pressure. (PPC)
This is a small device that blows high pressure air into the nose. To do this the patient wears a nasal mask at night to prevent the upper airway from collapsing. The quality of sleep is thus improved.
Two machines are currently available to patients.
The PPC has two pressure levels and the manual one which is currently the best choice adapts the pressure to the upper respiratory airways.
The ppc has immediate effect on apnea, hyponeas and snoring.
MY THERAPEUTIC INDICATIONS.
The treatment will be adapted to the situation and the patient's condition.
For simple snoring
Treatment with radiofrequency of the soft palate.
For case 2
Radiofrequency of the palate, or advanced mandibular ortheses.
For case 3
Advanced mandibular ortheses or continuous airway pressure VPPC
Advanced mandibular ortheses has become the most effective treatment of snoring and moderate sleep apnea.
It is partially reimbursed by the social security in cases of confirmed sleep apnea.
To conclude, the advanced mandibular ortheses has become an important tool in the therapeutic treatment of snoring and apnea. It is the treatment I advocate.
Any patient who snores should be anatomically assessed in order to be offered the appropriate treatment.