Featured Case 07/20: SNORING & SLEEP APNEA

Patient:

Doug

The problem:

"I snore and my wife cannot sleep”

Patient History

• Doug is a 37-year-old male with a history of loud snoring.
• He notes it has affected his wife’s sleep and impacted their relationship.
• He noted having to sleep in another room frequently.
• He desired to decrease his snoring and improve the quality of their lives.

Pertinent Information:

• Snoring is noisy breathing created by air turbulence along with the airway anatomy while you sleep.
• Commonly associated factors include restricted nasal passages, poor muscle tone of the throat and tongue, large-sized tongue and throat tissue, long soft palate and uvula, excessive alcohol use, and sleep position.
• It is a very common condition that affects both males and females, but males are more affected.
• Increasing weight and age are significant factors in addition to deformities of the jaw (retrusive), tongue (large), palate (long), face, and neck (large).
• Although snoring is not a direct health emergency, it most frequently is a nuisance for one’s bed partner and a primary reason for patients seeking care.
• Long-term snoring can affect sleep patterns and may be associated with Obstructive Sleep apnea (disturbances in breathing when asleep).

Exam and Diagnosis:

• Doug underwent a volumetric CT Scan analysis of his airway.

• Following the initial consultation, he also received a formal sleep study (polysomnogram) and was determined to have only very mild sleep apnea.
• His AHI was almost normal. The Apnea-Hypopnea Index (AHI) measures sleep apnea severity.
• The AHI is the sum of the number of apneas (pauses in breathing of at least 10 seconds) plus the number of hypopneas (periods of shallow breathing) that occur, on average, each hour.
• Doug was determined to have primary snoring and did not seek nor require any treatment for sleep apnea.
• We then performed a complete evaluation of Doug’s airway while he was sedated and asleep.
• This was performed with a tiny (3mm) flexible camera to assess his nose, oral cavity, and throat while sedated to reflect his muscle tone when he sleeps.

This procedure is called Diagnostic Nasopharyngoscopy.

Procedures:

• Nasal Septoplasty (correction of the crooked central portion of the nose)
• Bilateral Submucous Turbinectomies (reduction of the lateral portions of the internal nose without incisions)
• Uvulopalatoplasty (reduction and reshaping of the uvula and soft palate)

Commentary:

• While snoring may not be perceived as a health problem by most patients, it may be a symptom indicative of a bigger problem: Obstructive Sleep Apnea.
• Proper evaluation and diagnosis must be conducted to differentiate between snoring and obstructive sleep apnea so treatment options can be designed accordingly.
• Weight reduction and control can be a helpful adjunct to sustained treatment success.
• In our experience, the biggest problem with snoring lies with the bed partner.
• It is simply torture to try sleeping next to someone snoring. Snoring impairs the sleep quality of the bed partner and may be more harmful to their health.

We were so grateful that Doug was kind enough to share his experience with other patients and even more delighted that we were able to improve the quality of restful sleep for both him and his wife.