Sleep Endoscopy for Obstructive Sleep Apnea and Snoring

A new webpage has been created describing a procedure called “sleep endoscopy” or “sedated endoscopy.”

This procedure is performed on patients with obstructive sleep apnea (OSA) or severe snoring in order to determine where the source of their problem is anatomically located.

This special exam is needed in patients where such anatomic determination is not able to be made in the clinic while they are awake. As such, an anesthesiologist would put the patient to sleep using IV medications and when snoring or obstructive events happen, endoscopy is performed.

Areas that will be specifically examined during sleep endoscopy include:

• Behind the palate
• Uvula
• Back of Tongue
• Walls of the Throat
• Epiglottis
• Voicebox

Each of these areas may experience collapse during sleep causing obstructive or snoring symptoms.

Why is this information helpful? Well… once it is apparent where and what is the culprit causing a given patient’s problems, surgical treatment can be geared more specifically and directly to the area of concern seen during sedated endoscopy.

Read more here!

New Anti-Snoring Device… aveoTSD

I received in the mail today a new device called aveoTSD anti-snoring aid by Glidewell Laboratories.

According to the literature, the way it works is by advancing the tongue forward thereby preventing the tongue from falling backward and vibrating against the throat’s back wall causing snoring as well as obstructive sleep apnea.

The way the device moves the tongue forward is by literally suctioning the tongue tip into the device and holding it in place by vacuum seal.

The theory behind how this device works is sound and mimics what an oral appliance does as well as several surgical procedures including base of tongue reduction, hyoid advancement, and Repose procedure.

The one caveat I have with this device is that it only resolves snoring due to the tongue. It would not necessarily address snoring that comes from the nose or palate. There are other devices/surgeries that would address those areas (breath-rite strips, Pillar procedure, UPPP, septoplasty, etc).

I lied… there’s another caveat… Will the suction vacuum hold all night for a patient??? It does come in several different sizes… but still…

Read more about the aveoTSD here.

Read more about snoring here.

Tonsillectomy Causes Obesity?

MSNBC published a story on Feb 1, 2011 regarding a new study suggesting a link between childhood obesity and tonsillectomy.

What they found was a greater than expected weight gain in both normal weight and overweight children after tonsillectomy over a 6-12 month period of time. In one study, the average body mass index of the kids increased by about 7 percent. In another analysis of 249 children, 50 to 75 percent of kids had weight gain after surgery. While most weight gain happened in the first year after surgery, scientists don’t know definitively whether it levels off after that.

What is unclear about this research is whether this common surgery to remove tonsils is contributing to the nationwide “epidemic” of obesity.

Several theories have been proposed:

1) One reason why tonsillectomy is performed is because of difficulty breathing. In this scenario, more calories are expended on trying to breath. After tonsillectomy, all the energy expended on breathing is now being used to gain weight instead.

2) Having difficulty swallowing food due to large tonsils may prevent children from eating very much. In this scenario, after tonsillectomy, the child can now eat without problems leading to eating more and gaining weight.

3) In young and school-age children there’s evidence of both a weight gain and a “growth spurt” after tonsillectomy that may be triggered by higher levels of growth factors.

One needs to be careful and realize that this study does NOT prove cause and effect. It suggests a possible association and the only way to know for sure if this common surgery actually causes obesity is to perform a double-blinded, placebo-controlled, prospective study… or at the very least, a prospective study (given it will be near-impossible to have a placebo group and be double-blinded… after all, you can just look to know if the tonsils were removed or not). What will likely end up being true is the fact that obesity is due to a number of factors of which tonsillectomy may play one possible role in certain pediatric populations. In the end, more study is needed.

Regardless of the cause, perhaps the best advice for parents is to have tonsillectomy done for their child only if it is absolutely necessary and if done, keep an eye on how much they are eating and to encourage healthy eating habits.

Read the MSNBC report here.

Reference:
Pending in Feb 2011 Issue of Otolaryngology-Head & Neck Surgery

The Doctors TV Show Does Surgery for Obstructive Sleep Apnea

The Doctors TV show at some point in the past (not sure when), did a segment on surgery used to treat obstructive sleep apnea. The surgery portrayed was UPPP (uvulopalatopharyngoplasty). Dr. Brian Weeks, the featured otolaryngologist, removed the tonsils and uvula followed by suturing the cut mucosa to reposition the soft tissues of the patient’s throat.

This operation is a basic surgical method addressing obstructive sleep apnea. However, prior to considering surgical treatment, I typically recommend trial of CPAP for 3 months.

Some things to keep in mind is that obstructive sleep apnea is often due to multiple levels of obstruction. UPPP only addresses mouth-level problems. Other sleep apnea surgery options need to be considered when obstruction exists at other levels including the back of tongue (below the mouth level). Base of tongue reduction helps in this situation.

Watch the video of the TV show here. Watch the video our office produced on this surgery here.

http://r.unicornmedia.com/content.aspx?uid=AC26FE85-334B-4A21-B72C-154F743F5739&at=af886c81-206b-4c7c-ac4e-dc553df1fb75

New Video on UPPP Surgery to Treat Sleep Apnea (Uvulopalatopharyngoplasty)

A new video has been created and uploaded onto our YouTube channel showing how a UPPP (uvulopalatopharyngoplasty) sleep apnea surgery is performed. This surgery is commonly performed to try and improve or even cure obstructive sleep apnea in adults. This surgery rarely is performed in kids.

Read more about UPPP here. More info about obstructive sleep apnea can be found here.

Another operation used to treat obstructive sleep apnea in adults along with UPPP is base of tongue reduction. Read about this operation here as well as watch the video here.

Watch the video here.

Pacemaker To Cure Obstructive Sleep Apnea (OSA)?

The Washington Post on Dec 27, 2010 published a story about a potential new treatment whose goal is  obstructive sleep apnea cure (OSA) cure using a pacemaker made by Inspire Medical… for the tongue.

Apparently it stimulates the nerve going to the tongue (hypoglossal nerve) to contract with every breath a person takes while sleeping.

Why would this help? In some patients with severe obstructive sleep apnea, the tongue falls backward against the throat’s back wall (tongue prolapse) causing airway obstruction. By stimulating the tongue’s nerve, the tongue is stimulated to move forward when a patient takes a breath preventing obstruction.

Of course, this treatment works ONLY if the obstruction is due to tongue prolapse.

There are other treatments that also accomplish the same thing including:

• Base of tongue coblation/reduction
• Geniohyoid advancement
• Repose procedure
• Oral appliance

At least in our office, we only offer the base of tongue reduction to address tongue prolapse that may lead to obstructive sleep apnea.

This pacemaker for the tongue is currently experimental and not available for the general public yet.

Read the WP article here.

Sleep Apnea Can Mimic Dementia

NYT published a great article on Oct 6, 2010 regarding how obstructive sleep apnea (OSA) can mimic many of the symptoms of dementia, especially in the elderly.

Symptoms of OSA that can be confused with dementia include trouble concentrating, inattention, difficulty staying focused, constantly dozing off during the day, and other cognitive deficits.

Unfortunately, many elderly patients live alone and nobody is around to see whether there are any sleep issues. Most elderly patients deny any sleeping difficulties and it is not until someone stays with them during the night (like on holidays when family members are around) that a sleep disorder is noticed.

They key thing is to consider OSA in the differential for an elderly patient who may be exhibiting some symptoms of dementia and to realize that one needs to talk to family members whether sleep issues are present.

Read the NYT article here.

Read more about OSA here.

Read a study about the relationship between OSA and dementia here.

Reference:
Cognitive Effects of Treating Obstructive Sleep Apnea in Alzheimer’s Disease: A Randomized Controlled Study. Journal of the American Geriatrics Society Volume 56, Issue 11, pages 2076–2081, November 2008

ABC: Boy With Ondine’s Curse Must Think to Breathe

ABC news carried a story about a young boy named Liam Derbyshire who has an extremely rare sleeping disorder called Ondine’s Curse. The medical name is Central Hypoventilation Syndrome (CCHS).

As those familiar with folklore know, Ondine’s curse is after a mortal who fell in love with a German nymph. He swears that his daily breath is a testimony to her love. But when the man is unfaithful, the king punishes him by making him remember all his bodily functions INCLUDING breathing. When the mortal falls asleep he forgets to breathe and dies.

In this real story, the boy most consciously remember to breath ever breath in and out. If he forgets to do so, he literally stops breathing.

For those scientists, this disorder is due to a mutation in the PHOX2B gene.

Read the ABC story here.

Chronic Cough May Be Due to Obstructive Sleep Apnea!

A new study was published in the April 2010 journal Cough entitled “Chronic cough and obstructive sleep apnea in a community-based pulmonary practice.”

Apparently 44% of patients with a chronic mysterious cough were found to have obstructive sleep apnea. In these patients, 93% had cough improvement when the obstructive sleep apnea was corrected!

Read the abstract here.

Of course, there are many other causes of chronic cough including reflux, asthma, allergies, etc. In rare cases, when all else comes back normal, the cough may be due to laryngeal sensory neuropathy.

CNN: Obstructive Sleep Apnea Increases Risk of Stroke

CNN on April 8, 2010 aired a story on obstructive sleep apnea (OSA) and the risk it poses to men who do not address it. Apparently, according to a new study out of the March 2010 issue of the American Journal of Respiratory and Critical Care Medicine (“Obstructive Sleep Apnea Hypopnea and Incident Stroke: The Sleep Heart Health Study”), the risk of stroke increases by as much as 3X if left untreated in men with OSA. The risk of stroke increases even in men with MILD sleep apnea. The risk appears higher in men than women mainly because men seem to get it earlier and live with it longer than women.

Read the CNN story here.

Read the research study here.

Read more about OSA and its treatment here.