Apnea and Sleep Disorders

Definitions

Simple Snoring
Snoring alone, with no apnea, nor any negative thoracic pressure. O2 is normal.

Upper Airway Resistance Syndrome (UARS)
Snoring with negative thoracic pressure due to obstruction, but no apnea.  RDI may be between 5-20/hr. O2 may be <90% for brief periods.

Obstructive sleep Apnea (OSA)
Breath holding, often with choking, gasping and other signs of distress,    leading to RDI >20/hr. O2 is often quite low, < 80%, depending on length and amount of apneas measured by RDI.

Restless Legs Movement Syndrome (PLMS)
Periodic, jerking leg motion during sleep.

Diagnostic Performa
History from bed-partner-->Snoring/Apnea Questions
Questionnaires-->Epworth Sleepiness Study (ESS)

Exam of nose, throat and hypo-pharynx

Rhinomanometry to assess nasal (upper) obstruction.
Fiberoptic Video Laryngoscopy to assess sites of obstruction in (lower) hypopharynx and base-of-tongue.

Oximetry-screening in home 
Polysomnography and Split-Night Oximetry CPAP titration in approved sleep lab, to diagnose apnea and determine settings for CPAP machine.

Treatment

CPAP titration to determine pressure level.
CPAP treatment to improve physiology to near-normal.
Surgery maybe indicated, once physiology stabilized.

Overview of RDI Continuum

Normal    ||           UARS            ||                    Pathologic (OSA)    
RDI---------->-------------------------------->--------------------------------------->

RDI   0      5                              20                                         80

Sites of Obstruction and Treatments

Nose

Turbinate reduction with Somnoplasty

Turbinate resection or SMR of turbinate

Septoplasty

Sinus surgery (FESS)

Nasal polypectomy

Soft Palate

Soft palate reduction with Somnoplasty

Uvulectomy   

Laser Assisted Uvulopalatoplasty (LAUP)

Uvulopharyngopalatoplasty (UPPP or UP3)

Tongue