Slide 2 Trends in Management of Snoring Deepak Gupta Department
of Otolaryngology The Great Western Hospital & The Ridgeway
Hospital Swindon Slide 3 Snoring Definition: Rough, noisy breathing
during sleep, due to vibration of uvula and soft palate, maybe
tongue Mechanism: Obstructive air flow leading to turbulence which
vibrates soft tissue in the mouth and throat to produce sound.
Incidence: Men 24% - 50%, women 14% -30% Slide 4 Sleep-Disordered
Breathing (SDB) Simple Snoring Upper Airway Resistance Syndrome
(UARS) Mild Obstructive Sleep Apnea Syndrome (OSAS) Severe
Obstructive Sleep Apnea Syndrome (OSAS) Slide 5 Collapsible
Portions of Upper Airway Slide 6 Consequence of Snoring Social the
sound of Snoring may lead to marital disharmony or social
embarrassment Sleep disturbance and fragmentation lead to excessive
daytime sleepiness e.g. traffic accidents Sore throat Slide 7 Slide
8 Quantifying Snoring Frequency Position sensitivity Witnessed
apnoeic episodes Duration Degree of disruption Slide 9 Clinical
Assessment Obesity Neck Circumference Alcohol Smoking Daytime
Sleepiness Witnessed Apnoeas Abnormal nocturnal motor activity
Other nocturnal events Epworth Slide 10 Clinical Examination Body
Mass Index (BMI)/Neck Nasal Obstruction Oral cavity/Oropharynx
Laryngoscopy Slide 11 Slide 12 Slide 13 Signs/Symptoms of Sleep
Apnea Breathing sounds during sleep Excessive daytime sleepiness
Fatigue Changes in alertness, memory, personality Hypertension/CHF
Impotence Headaches Bedwetting Slide 14 Assessment of Sleep Apnea
Epworth Sleepiness Scale Nocturnal oxygen saturation Home sleep
testing -Apneagram Polysomnography Slide 15 Epworth Sleepiness
Scale 0-24 Sitting and reading Watching TV Sitting inactive in a
public place As a passenger in a car for an hour Resting in the
afternoon Sitting and talking to someone Sitting after lunch
without alcohol In a car while stopping for a few minutes in
traffic Chance of dozing 0=never 1=Slight 2=moderate 3=High Slide
16 How to assess the region of obstructions To determine a surgical
procedure it is valuable to know the location of the nocturnal
obstruction. Slide 17 Deciding on a Treatment Option Slide 18
General Treatment for SDB Control of body weight Behavioral
modification avoid full dinner and excess alcohol sleep in lateral
or prone position Slide 19 Patient Administered Treatments Worth a
Fortune! Slide 20 Slide 21 Slide 22 Slide 23 Slide 24 Oral
Appliances Mandibular repositioning devices(MRD) Tongue retaining
devices Slide 25 Slide 26 MRD Good compliance Reduce frequency,
intensity and duration of snoring Xerostomia TMJ pain Dental pain
Myofacial pain Bite change Slide 27 Nasal CPAP Very effective Low
compliance when used for snoring alone 70% prefer less effective
MRD Slide 28 Slide 29 http://www.dailymail.co.uk/
health/article-81411/Ten- snoring-cures.html
http://www.dailymail.co.uk/ health/article-81411/Ten-
snoring-cures.html Slide 30 Surgical Interventions Nasal Surgery
poor prediction of success Adenoid/Tonsil Surgery Palatal Surgery
50-95% short term success 45-75% long term success Poor correlation
between objective decrease in intensity and subjective improvement
Maintenance of fall in snoring volume Tongue base surgery Jaw
advancement Hyoid myotomy and suspension Tracheostomy Slide 31 Why
should we operate May be the only tolerable option Only permanent
option Good results Mimimal complications Slide 32 Why not to
operate Variable success Insufficient evidence base May make future
CPAP use difficult Recurrence with time and age Slide 33 Intra
Palatal Surgery Diathermy Cold steel Radiofrequency Laser Injection
Sclerosis Intra palatal devices Low morbidity LA Out-Patient
Procedure Repeatable UPPP still possible SR 30-80% in short term
Possible decrease in long term Best for BMI less than 25,Tonsil
grade 1 & 2, AHI less than 25 Slide 34 Radiofrequency Ablation
RFA Snoring, mild/moderate OSAS Interstitial volume reduction and
stiffening Local anaesthesia/out patient Day procedure Slide 35
Slide 36 Slide 37 Slide 38 Slide 39 Slide 40 Anti-snoring device
(ASD implants) Pi Medical (Minnesota, USA) Year 2000 Increase
stiffness of soft palate Permanent implant Slide 41
Uvulopalatopharyngoplasty * * * Slide 42 Laugh and the world laughs
with you snore, and you snore alone - Mark Twain Thank You and
sleep well
