The UAB Division of Otolaryngology-Head and Neck Surgery offers specialized care for the evaluation and treatment of patients with snoring and obstructive sleep apnea. Our goal is to provide exceptional, comprehensive, and state-of-the-art treatment that is tailored to the individual needs of each patient with sleep-disordered breathing.
Snoring and obstructive sleep apnea (OSA) are the most common manifestations of sleep-disordered breathing. Individuals with disruptive snoring, witnessed episodes of cessation of breathing, excessive daytime sleepiness, or other signs and symptoms of sleep disordered breathing should undergo a formal sleep study to confirm the diagnosis. Additionally, it allows the fitting and titration of positive pressure therapy (i.e., CPAP) if indicated. Currently, positive pressure therapy is the most effective and consistent treatment for obstructive sleep apnea in patients who can and will use this modality. This evaluation and the subsequent relationship with the sleep medicine physician is crucial to successful management of OSA.
Obstructive sleep apnea is characterized by repeated blockage of the breathing passages of the nose and throat during sleep. This, in turn, leads to decreased blood oxygen levels, repeated awakenings or arousals, and disruption of sleep. While many potential negative consequences of OSA exist, they can largely be divided into two main categories: health effects and quality of life effects. While research into the untoward health impacts of OSA is providing us with new data almost daily, some negative effects can been clearly shown to exist. Untreated OSA is strongly associated with the risks of developing hypertension, stroke, heart attack and early death, and these risks are greatest in those with more severe disease. Despite this, the main reason most patients initially seek help with OSA is as a result of the negative quality-of-life impact. Repeated arousals and disruptions of sleep lead to non-restorative sleep. Patients can suffer from excessive daytime sleepiness, diminished cognitive abilities such as memory, work problems, and even accidents (i.e., motor vehicle accidents). Finally, while snoring may go unnoticed by the snorer, it can certainly be the source of substantial problems with bed partners or even people sleeping in another room.
Non-surgical treatments for snoring and obstructive sleep apnea include weight loss, positional therapy to avoid sleeping on one's back, avoidance of alcohol or other sedating medications, and positive pressure therapy such as CPAP or BiPAP. The latter uses air pressure delivered via a tight-fitting mask to 'splint' the airway open, thereby eliminating the obstruction. As previously stated, it is currently the first-line treatment for obstructive sleep apnea because it is highly effective when patients can wear it and sleep comfortably through the night every night. Unfortunately, non-compliance with CPAP therapy is thought to be as high as 50%. While many reasons for non-compliance exist, we believe that it is very important that medical and surgical sleep providers work with these patients in attempts to improve compliance when possible.
Surgical treatment of patients with OSA can be thought of as either adjunctive therapy or salvage therapy. In the former, the goal is to improve some aspect of the airway with the goal of improving treatment compliance by increasing the tolerability of PAP or oral appliance. This approach most often involves nasal surgery as nasal obstruction is associated with decreased CPAP acceptance and increased CPAP pressures. Occasionally, tonsil and/or conservative palate surgery may also have a role in this approach. With salvage therapy, the goal is to utilize surgical procedures as the primary treatment modality in hopes of needing no additional treatment for OSA. While it is generally believed that surgery cannot achieve the same improvement in severity of obstructive sleep apnea compared to CPAP (though it may in some cases), surgical therapy is not plagued by the same issues of non-compliance.
It is our belief that successful surgical treatment of obstructive sleep apnea starts with accurate identification of the pattern of airway obstruction followed by the development of an effective, comprehensive treatment plan. There are three major areas at which airway blockage can occur: thenose, tonsils/palate and tongue regions. Each patient treated at UAB will undergo an individualized evaluation to determine which areas are involved. Commonly, patients will have more than one area of obstruction.
Some procedures offered by UAB Division of Otolaryngology-Head and Neck Surgery for the treatment of snoring and obstructive sleep apnea are:
- Nasal surgery
- Rhinoplasty (i.e., nasal valve repair)
- Turbinate Reduction
- Sinus Surgery
- Palate Surgery
- Lateral pharyngoplasty
- Pillar Implants
- Radiofrequency Palatoplasty
- Tongue Base Surgery
- Hyoid suspension
- Genioglossus advancement
- Robotic Surgery
- Lingual tonsillectomy
- Tongue base resection (robotic, CO2 laser)
- Tongue base radiofrequency
- Epiglottic surgery (partial epiglottidectomy, epiglottopexy)
Currently UAB Division of Otolaryngology-Head and Neck Surgery is involved in state-of-the-art research to investigate the use of the da Vinci robot for surgical treatment of the tongue base in obstructive sleep apnea. In addition, we will be one of the medical centers in the STAR trial investigating the Inspire II hypoglossal nerve stimulator for the treatment of obstructive sleep apnea.