SURGICAL PROCEDURE FOR SNORING AND SLEEP APNEA

Snoring is the mildest respiratory disorder seen during sleep, the most severe form of obstructive sleep apnea. Snoring occurs in at least 10% of normal adult people and in 12% of the children. Over the age of 60, this rate rises to around 40-50%. Snoring problem is most commonly seen in middle-aged, obese adult males and the incidence increases by age.

WHAT IS SNORING?

Snoring is the sound that occurs when the airway behind the nose and tongue is narrowed during sleep and the vibration of the small tongue or pharyngeal structures. Tonsils, back of the tongue, soft palate, small tongue and throat that occur in the muscles of the nasal and pharynx of the airway narrowing with any pathology is not very rare. When there is constriction in this region, especially small tongue and soft palate vibrate and snoring occurs with increasing breathing effort during sleep.

CAUSES OF SNORING AND SLEEP APNEA MAY BE SUMMARIZED AS FOLLOWS;

Tension of the muscles of the small tongue, soft palate, tongue and throat is reduced in cases such as excessive weight, sedative medication or sleeping medicine intake, alcohol use. In overweight people, fat accumulation is seen around the pharynx. When the relaxed muscles lie on your back, you cannot prevent the tongue and the small tongue from sliding towards the back of the throat. As a result of alcohol or medication, muscle tone becomes more relaxed and snoring and later stage obstructive sleep apnea begins.
Smaller tongue, soft vein, tonsils, tongue root and surrounding structures are larger than normal size or reduced by nervous mechanisms and tension.
Contrary to common knowledge, large tonsils and nasal flesh need not necessarily be the cause of snoring and sleep apnea in children. It should be remembered that tonsils and nasal flesh of normal size also cause snoring and apnea.
Some children are in the high-risk group. Children under two years of age, children with recent upper respiratory tract infections, craniofacialal abnormality, neuromuscular disease, premature, overweight children and children with cardiac problems are included in this group.
In obese people, the reason is that the neck diameter is higher than normal.
Obstruction of the upper respiratory tract due to cysts and tumors causes snoring and sleep apnea.
Snoring is also seen in people with nasal obstruction. In these people, breathing effort to get air in sleep creates negative pressure in the nasal cavity and the tissues in the throat are drawn towards the airway. As a result, when the nose is open, the person who does not snore begins to see snoring. This explains why some people snore only during allergic periods or when there is influenza sinusitis. Deviations in the middle part of the nose, nasal polyps, enlarged turbinates, tumors in the nose and nasal passages are considered to be the causes of snoring causing this type of nasal congestion.

WHAT IS OBSTRUCTIVE SLEEP APNEA?

The simplest definition of sleep apnea is the cessation of breathing during sleep. If the patient has severe snoring during sleep, soft palate, small tongue and congestion or obstruction in the airway behind the tongue occurs, it means obstructive sleep apnea. Obstructive sleep apnea occurs in at least 5 out of 100 people. In overweight middle-aged men, the ratio increases more. It was reported that the incidence of obstructive sleep apnea in children is 10-12%.

HOW DOES SLEEP APNEA AFFECT OUR HEALTH?

A good night sleep is essential for a healthy life. There will be nights spent resting as a result of the disturbance of the night sleep pattern by obstructive sleep apnea. People with obstructive snoring defect can enter the deep sleep phase in a very small part of their sleep. Deep phase is the only way for real rest. After a restful and restless night, a sleepy, tired and inefficient day will begin. While watching television or mild sleepiness after dinner, more serious problems will arise with the increase in the severity of apnea. Naps during driving or on the job.

When the most severe form of snoring, “obstructive sleep apnea ”occurs, life-threatening problems begin to emerge. During night sleep, apneas may reach up to 100-200 attacks per hour. During apneas, the blood oxygen level drops and the heart is forced to pump more blood. As heart rhythm deteriorates, high blood pressure, heart enlargement and even sudden death in sleep may occur over the years.

Sleep apnea is more common in preschool children. If not realized, serious problems such as developmental delays, lagging of weight and height in children, school failure and mental development problems may arise. In addition, behavioral disorders, hyperactivity, bed voiding at night, heart and rhythm disorders may be seen.

HOW IS SNORING AND SLEEP APNEA DETECTED?

Snoring or apneas may be detected by the individual's family or relatives during the follow-up during sleep. In this case, a doctor should be consulted and the cause must be determined. Children who snore must undergo scanner tests. Your doctor's nose, throat and neck examinations will reveal whether the condition is caused by a simple snoring or obstructive sleep apnea, and if necessary, an examination in a sleep center is possible.

WHAT METHODS ARE IMPLEMENTED FOR TREATMENT?

In adults, there are some situations in which snoring people should pay particular attention. The following recommendations should be followed.

Excess weight gain should be given and a sporty lifestyle should be chosen to gain a good muscle tone.
Alcohol intake should be restricted.
The use of allergy medications called sleep medicines, sedatives and antihistamines should be considered as they may increase apnea.
Heavy meals should be avoided 3-4 hours before sleep.
Excessive fatigue should be avoided.
Rather than sleeping in the supine position, sleeping sideways should be preferred.

The most widely accepted and widely used method as the primary treatment of the disease is CPAP devices which send compressed air to the airways of the patients with the help of a mask and hose. Despite their high effectiveness in treatment, these devices are not preferred in the long term due to the inconveniences and side effects of the users.

Very good results can be obtained by surgical intervention in selected cases of sleep apnea. With the selection of patients who can benefit, the success in treatment increases up to 80-90%. A thorough upper airway examination and, if necessary, sleep endoscopy can be used to determine the exact location or location of the problem and to perform surgical procedures for those areas.

SURGICAL PROCEDURES

Surgical procedures of the nose are as follows:

Septoplasty
Conchaplasty
Nasal valve surgeries
Nasal polyp surgery

Surgical procedures of Palate and throat:

Tonsillectomy
adenoidectomy
Soft palate radiofrequency
uvulopalatoplasty
Lateralpharyngoplasty

Surgical procedures of the tongue base:

Radio frequency
Excision of the tongue base mass
Tongue base lifting

HOW IS SNORING SURGERY DONE?

Snoring surgery is performed under general anesthesia. It takes about 1 hour. In this surgery, small tongue is cut, soft palate is stretched and tonsils are removed.

AFTER SNORING SURGERY

The postoperative progress of the snoring surgery is as follows;

The patient usually stays in hospital for 1 night.
After the surgery, food may enter the nasal passages, nasal discharge, difficulty swallowing, bleeding, taste disturbance, but this is a temporary condition.
Especially after the first 5-7 days pain occurs. Then gradually decreases.
Dry mouth and throat sensation persists for a relatively long time.
The effect of the surgery is seen after about 3 weeks. Snoring may worsen earlier, which is normal.

POINTS TO BE CONSIDERED AFTER SNORING SURGERY

The following should be considered after snoring surgery;

The patient should be fed with juicy and soft foods for several days after the surgery.
Foods that may cause irritation (such as hot, spicy, bitter and acidic) should be avoided for several days.
Tobacco and alcohol products should not be used for 1 week following the operation.
Prescribed medicines should be used regularly.
Keep the head high for 1 week following the operation (2-3 pillows can be placed).
If you experience respiratory distress, excessive swallowing, excessive bleeding, seek medical advice immediately.