Obstructive sleep apnea (OSA) is a condition where the soft tissues of the airway collapse causing moments of cessation of breathing. The collapse can occur at the level of the soft palate and/or the tongue base. Anatomic factors that can contribute to OSA include obesity, thick neck size, enlarged tonsils, large soft palate, thick and elongated uvula, abnormal positioning of the jaws, large tongue base, and lingual tonsil hypertrophy.
The symptoms of OSA include:
- Gasping or choking episodes at night
- Restless sleep with tossing and turning
- Frequent awakenings to go to the restroom
- Morning headache
- Waking up feeling unrefreshed
- Daytime fatigue and sleepiness
If left untreated, OSA can lead to hypertension, cardiovascular disease, and pulmonary hypertension.
The gold standard for diagnosing OSA is polysomnography (PSG), also known as overnight sleep study. A number of body functions are monitored during the study. The AHI (apnea hypopnea index) is the number of episodes of decreased breathing that occur divided by the total sleeping time in hours. This number is used to categorize the severity of OSA.
- Mild: AHI 5-15
- Moderate: AHI 15-30
- Severe: AHI greater than 30
The mainstay of treatment is nasal CPAP
CPAP involves positive pressure breathing which helps to open the areas of collapse within the airway and provide oxygen to the lungs. The main issue with CPAP is compliance, which is only around 50%. When CPAP is not tolerated, then surgery becomes a consideration. The most common procedures performed for OSA are tonsillectomy, uvulopalatopharyngoplasty (UPPP), tongue base reduction procedures, septoplasty and turbinate reduction. Also, surgical intervention can help to decrease the pressure settings on the CPAP machine, allowing it to be more tolerable and thus improve patient compliance.