Snoring and Sleep Apnea

• Nasal congestion
• Blocked nose
• Allergic rhinitis

• Tumors
• Oedema

• Enlarged adenoid
• Enlarged tonsils
• Large tongue
• Elongated Uvula
• Thick neck as in obese

• Down syndrome
• Children with abnormal face
• GERD
• Smoking (active and passive)
• Family history of Sleep apnea

• Fatigue and tiredness during the day.
• Loud snoring.
• Waking up with choking or gasping.
• Not feeling rested in the morning or satisfied with a night’s sleep.
• A strong desire to take a daily afternoon nap.
• Unexplained accidents or errors.

Other Common Features are

• Obesity
• Small jaw, thick neck
• High blood pressure
• Restless sleep, the repeated struggle to breathe can be associated with a great deal of movement.
• Depressed mood and/or irritability
• Reduced sex drive and impotence
• Snorting, gasping, choking during sleep

• Sleep apnea is a potentially life-threatening condition.
• Undiagnosed severe sleep apnea can cause irregular heartbeats, unstable high blood pressure, leg swelling, heart attack, stroke, cardiac arrest during sleep, or a harmful accident.
• Increased daytime sleepiness poses a serious risk of automobile accidents, impaired functioning
  in the workplace and in personal relationships.

Complication of Obstructive Sleep Apnoea

• High Blood pressure
• Fatigue
• Heart disease and heart attack
• Stroke
• Untreated sleep apnea tends to progressively worsen and can cause partial or complete disability and death.

General measures

• Regular exercise
• Weight loss
• Avoid heavy dinner
• Healthy high fiber diet
• Develop regular sleeping patterns
• Tilting the top of a bed upward a few inches,
• Sleeping on the side
• Avoid alcohol/smoking
• Avoid allergy triggers (stuffed animals, pets, and feather/down pillows from the bedroom.
• Avoid sleeping pills and antihistamines before bedtime

Nasal Continuous Positive Airway Pressure (NCPAP)

CPAP (Continuous positive airway pressure by a nasal mask throughout the night) is the most effective and frequently used treatment for OSA. Compliance is a major problem but family should be motivated as major surgeries can be avoided. The sleep study should be repeated every 6-12 months with upper airway growth with age.

Oral Appliances (OA)

Mouthpieces worn at night works by repositioning the tongue or mandible forward

Nasopharyngeal airway. It may be the only treatment required for some children. Like Adequate airway is developed by the age of about 3 months in Pierre Robin syndrome.

The major complication of OSAS is reversible before the end-stage heart and lung disease, therefore, surgery should be done for obstructive lesions of upper airway as soon as possible.

• Tonsillectomy and Adenoidectomy (TAR / T&A) cures most children and it should be the initial treatment in children with other factors also.
• In patients with craniofacial anomalies, specific surgery can be done.

Nasal Surgeries

Nasal obstruction makes CPAP difficult to tolerate. Surgery is done to open the nasal passages such as septoplasty to correct deviated nasal Septum, Turbinoplasty/turbinectomy to reduce enlarged turbinates or FESS for Nasal Polyps.

Open nasal passages markedly improve tolerance to CPAP.

UPPP is done in selected cases usually LASER assisted the tonsils are removed, the uvula is removed, and the palate is trimmed higher.

Tongue reduction surgery

In some people with obstructive sleep apnea, the area of collapse is between the base of the tongue and the back wall of the throat (pharynx). Several surgeries have been used to decrease the size of the tongue.