Sleep Apnea

What is Sleep Apnea?

Sleep apnea is a potentially serious and sometimes life-threatening condition affecting 2% of women and 4% of men.  Patients with sleep apnea not only snore, but also experience episodes of respiratory obstruction and apnea with interruption of breathing for periods of greater than 10 seconds.  The episodes of pauses of breathing and snoring are obvious to the sufferer’s bed partner.

Untreated Sleep Apnea

Multiple studies over the last several decades have revealed that episodes of apnea, with a decrease in blood oxygen and an increase in blood carbon dioxide, places a significant stress on the patient’s cardiovascular system. This leads to hypertension and an increase in incidence of heart attacks and strokes.

Most patients referred to Dallas ENT Group have been evaluated by a sleep medicine physician and have already completed a sleep study. When patients have tried and been unsuccessful with the use of a CPAP (Continuous Positive Airway Pressure) machine and other sleep apnea interventions, Dallas ENT Group can sometimes provide a more permanent solution.

What does a typical sleep apnea evaluation look like?

Patients that have not been evaluated by a sleep medicine physician undergo an extensive history of their snoring and apnea to determine whether or not the patient experiences daytime drowsiness, true apneic episodes and respiratory pauses, and symptoms of nasal obstruction.  A complete head and neck exam including blood pressure, pulse rate, weight, height, calculation of body mass index, and neck circumference is obtained.  The patient is referred to a sleep center for evaluation and possible therapy with a CPAP machine.  The patients then undergo “a split night study” in which the patient is evaluated while they sleep.  The first half of the night determines the extensiveness of their sleep apnea.  The second half of the study allows the technician to determine the proper mask fit and pressure required.

What is a Continuous Positive Airway Pressure (CPAP) machine?

A CPAP is a machine that consists of a mask and tube and is worn at night to help a person breathe. The CPAP machine functions to regulate a person’s airway through forced pause and pressure. This allows for adequate airway expansion, ventilation, and oxygenation.  The CPAP functions in a biphasic fashion.  Expansion occurs followed by relaxation to allow for exhalation.

Patients that tolerate the CPAP well are seen back in the surgeon’s office for follow-up and encouragement for continued CPAP therapy.

Will I be successful with a CPAP Machine?

About 50% of patients are unsuccessful with a CPAP machine (though some studies suggest that number is as high as 70% to 80% of patients).  In the last several years, significant advances have been made in decreasing the failure of CPAP associated with computerization; but the high rate of noncompliance remains.

The Surgical Institute for Sleep Apnea (SISA) was created to evaluate CPAP failures.  The multidisciplinary team faces a challenging approach to maximize the therapeutic benefit to the patient.  There are very few programs in the country that effectively evaluate and treat the large number of CPAP failures.  Stanford University Sleep Program was developed a number of years ago and remains a standard for other multidisciplinary teams.

Patients that failed CPAP therapy are referred to the multidisciplinary team of the Surgical Institute for Sleep Apnea.  Patients are then evaluated extensively; reviewing their medical history and sleep studies as well as any therapeutic approach that they have tried.  In addition, a full head/neck physical examinations performed by members of the 3 disciplines including orthodontics, ENT, and Craniofacial plastic surgeons.  The orthodontist evaluates the patient’s occlusion, maxillary and mandibular relationship.

After a complete evaluation, the multidisciplinary team will discuss the findings and recommended to the patient the appropriate therapy.

What if CPAP didn't work for me?

When conventional sleep apnea treatments fail, Dallas ENT Group offers a more invasive treatment called a Uvulopalatopharyngoplasty (UPPP or UP3).

Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure that treats sleep apnea by removing excess tissue in the throat and, as a result, widening the airway. This allows air to move through the throat more easily when you breathe, effectively reducing the symptoms of snoring and sleep apnea.

Who is a candidate for UPPP?

UPPP is recommended for patients with excess tissue in the nose, mouth or throat that blocks the airways and causes breathing abnormalities during sleep. It can also be used after life changes and conservative treatment methods have failed. In addition to widening the airway, UPPP also aims to improve the movement of the soft palate and help the airway remain open during sleep.

How is UPPP surgery performed?

During the UPPP procedure, tissue may be removed from the uvula, soft palate and throat, depending on the location and severity of each patient’s individual condition. If the tonsils and adenoids are still intact, they will also be removed during UPPP. This procedure can also be performed using laser energy for more precise, less invasive results. Recovery usually takes about three weeks, during which time patients may experience difficulty swallowing.

Your doctor will discuss these risks with you, as well as address any concerns you may have, prior to your procedure.

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