What are sleep-related breathing disorders?
Sleep-related breathing disorders refer to conditions such as obstructive sleep apnea (OSA) and habitual snoring in which the upper airway becomes blocked while sleeping. OSA, the most serious sleep-related breathing disorder, occurs when tissues in the back of the mouth and throat block the airway for at least 10 seconds, resulting in an inability to breathe. The brain senses that the body is suffocating from a lack of oxygen and arouses the person to a light sleep, causing the throat muscles to contract and allowing a small passage of air that is accompanied by a gasping sound. The person falls back into deeper sleep until the muscles relax again, blocking the upper airway and repeating the cycle of arousal. Arousals may occur hundreds of times each night but the patient is never fully awakened, and thus unaware of the loud snoring, choking, and gasping for air that occurs while sleeping.

Habitual snoring, a condition that is sometimes a precursor to OSA, is caused by the vibration of the uvula (floppy tissue that hangs down from the back of throat). Because habitual snoring can be associated with other health problems, the condition should be discussed with a medical professional. Typically, it is the bed partner who is most aware of a patient’s snoring, since the loud snoring noise can prevent or interrupt sleep.

What are the health implications of sleep-related breathing disorders?
Sleep-related breathing disorders have a significant impact on an individual’s health. The lack of restful sleep associated with these disorders often results in excessive daytime sleepiness, making people less productive and irritable, and causing memory difficulties. Drowsiness associated with OSA significantly increases the probability of automobile accidents and, according to the National Commission on Sleep Disorders Research, OSA-related drowsiness may be involved in 36% of all fatal traffic accidents .

Sleep apnea may increase the risk for a number of diseases such as high blood pressure, stroke, heart attack and heart failure. Data from the Sleep Heart Health Study (SHHS) found that OSA sufferer’s are at an increased risk of developing hypertension, particularly middle-aged individuals. Over the long term, patients with sleep apnea are twice as likely to have a stroke or heart attack within ten years than those with out it . Research estimates that 38,000 cardiovascular deaths due to sleep apnea occur each year .

Loud snoring and intermittent breathing interruptions caused by sleep-related breathing disorders can disrupt a snorer or OSA sufferer’s sleep, as well as the sleep of a bed partner .

Witnessing an apnea can be a frightening experience because the obstructive sleep apnea patient appears to be suffocating. Frequently, it is a sleep-deprived bed partner who convinces the sufferer to seek medical help.

How common are sleep-related breathing disorders?
Twenty-four percent of adult men and nine percent of adult women, or more than 20 million Americans, are estimated to have some degree of OSA and of those, six million are estimated to have cases severe enough to warrant immediate therapeutic intervention . However, because OSA was not well understood or recognized by primary care physicians until recently, it is estimated that only 3% of those afflicted with OSA have been diagnosed and are currently
undergoing treatment . Ninety-five percent of OSA sufferers don’t even know they have this problem .

Habitual snoring is most prevalent in adults and altogether, affects more than 20 million Americans. Research indicates that in a 30- to 35-year old population, 20% of men and 5% of women will snore and by age 60, 60% of men and 40% of women will snore habitually . Currently, the number of people who snore exceeds the number of people who have asthma, and in middle-aged to older men, it is probably on the same order of magnitude as the number who smoke cigarettes .

Who suffers from sleep-related breathing disorders?
While sleep-related breathing disorders are commonly associated with obesity and men, they affect a broad cross-section of the population. OSA usually worsens with age because the throat tissues become floppier and weight gain is more common . Among the elderly, sleep-related breathing disorders are even more common, with 60% showing disturbances during sleep .

How are patients with sleep-related breathing disorders diagnosed?
If one suspects a breathing disorder or snores at a level that is uncomfortable for his or her bed partner, a doctor should be consulted. Typically, a doctor will recommend that the patient undergo an overnight sleep study to measure blood oxygen saturation and determine how much oxygen is inhaled during sleep. Generally, the level of oxygen in one’s blood indicates the severity of OSA.

What treatment options are available for patients with sleep-related breathing disorders?
For OSA patients, traditional therapy includes the nightly use of continuous positive airway pressure (CPAP), in which a mask is fitted over the patient’s nose and air is forcibly delivered by a pump. CPAP is effective, but many patients find the mask uncomfortable, claustrophobic, or embarrassing. CPAP patients often suffer from side effects related to forced air delivery including nasal congestion, sore eyes, headaches and abdominal bloating, and about half of CPAP patients discontinue long-term treatment . An alternative to CPAP and more invasive surgical procedures is the Somnoplasty^® Procedure. Performed under local anesthesia, this procedure treats sleep apnea and habitual snoring by shrinking soft tissue in the upper airway including the base of tongue. A summary of treatment options for patients with sleep-related breathing disorders follows.

Treatment Options for Sleep-Related Breathing Disorders

Treatment Indications Overview Risks Efficacy
Somnoplasty Procedure

Treatment	Indications	Overview	Risks	Efficacy
Somnoplasty Procedure	OSA/ Snoring	Outpatient procedure in which temperature-controlled radiofrequency energy is used to shrink excess tissue in upper airway	Some patients who undergo a Somnoplasty procedure may experience swelling, crusting, bleeding, and minor discomfort. The Somnoplasty procedure for the treatment of obstructive sleep apnea may cause moderate throat pain during the first week after treatment. Generally patients do not need prescription medications to manage these symptoms and typically return to normal daily activities the following day.	OSA patients treated with Somnoplasty in one study experienced more than a 50% reduction in their sleep interruptions and reported both a decrease in daytime sleepiness and an improvement in their quality of life. Approximately 80% of habitual snorers, in two studies reported improvement after two treatments,.
CPAP	OSA	Continuous Positive Airway Pressure (CPAP) involves wearing a face mask nightly that forces air into nasal passages	Many patients find the mask uncomfortable, claustrophobic, or embarrassing. Side effects include nasal congestion, sore eyes, headaches, and abdominal bloating.	CPAP is effective, but about half of CPAP patients discontinue treatment. Since CPAP is not a cure and must be used every night for life, non-compliant patients experience a full return of OSA and related symptoms.
Oral Appliance	Snoring/ OSA	OTC or Rx mouth guard used nightly to reposition one’s jaw or tongue during sleep	Over-the-counter devices can produce nasal and skin irritations, headache, sinusitis, jaw discomfort, and excess salivation,,.	Devices are only palliative and result in a low level of patient satisfaction and compliance.
LAUP	Snoring/ Mild OSA	Laser-Assisted Uvulopalatoplasty (LAUP) is the surgical resection of the uvula and palate with a laser	Procedure presents a risk of significant swelling, scarring, and post-operative pain, requiring a short period of close monitoring. Procedure requires narcotic analgesics post-operatively, usually prescribed for two weeks.	LAUP has limited effects in treating OSA because obstruction usually occurs in multiple sites. 77.4 % of patients reported reduced snoring after treatment with LAUP in one study.
UPPP	Snoring/ OSA	Uvulopalatopharngoplasty (UPPP) is an invasive procedure involving the surgical resection of the uvula, part of the soft palate, tonsils, and other excess tissue in the throat	Patients undergoing traditional surgery such as UPPP can suffer significant pain and take narcotic medications for several weeks. General anesthesia and an overnight hospital stay usually involved.	UPPP has limited efficacy, with success rates ranging from 30 to 50% . Relapse is common after five years, and in some cases, sleep apnea may be worse after UPPP, presumably due to altered airway structures.
Mandibular Advancement	OSA	Surgery that involves moving the tongue or jaw forward to make the airway passage bigger	Treatment is very invasive and expensive, may require general anesthesia and hospitalization, and result in a lengthy, painful recovery period.	Mandibular advancement has a 55% success rate for mild to moderate OSA patients
Tracheostomy	OSA	Surgical procedure in which a collateral airway is opened through the neck	Treatment is invasive and expensive, may require general anesthesia and hospitalization, and result in a lengthy, painful recovery period.	Although a tracheostomy is highly effective, it is an extreme measure that is poorly tolerated by most patients and rarely used.

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