Kids that have OSA do so typically due to chronically enlarged adenoids and tonsils. Tonsillectomies and adenoidectomies are successful at diminishing OSA substantially. The difficulty level associated with operations to reduce OSA in children can be very high, as for example with cases of reduced growth of the body alongside poor development of the right side of the heart. Fortunately, when OSA-associated high exhalation pressures are lowered complications to the cardiovascular system tend to reverse of their own accord. Careful precautionary practices are adhered to during the important postoperative period in children.

OSA treatment in adults who have poor oropharyngeal airways in combination with a large upper body frame are open to a variety of treatments. Unfortunately, this most common form of OSA tends not to have particular treatment methods that habitually work, each case needs specific evaluation over the best course of action.

Such methods for relieving obstructions consist of changes to the sufferer’s lifestyle, e.g. reducing alcoholic intake, avoiding medications that may relax the central nervous system (CNS) (e.g. sedatives, muscle relaxants), stopping smoking and reducing weight. Specially designed devices, such as pillows, that stop the sufferer from sleeping on their back can be effective in reducing OSA.

Oral appliances are sometimes used, these keep the patients airways open whilst they are asleep. Mandibular advancement splints (MAS) are sometimes advised to lessen mild to moderate OSA. MAS consists of a mouth guard, similar to that used with impact sports to protect the teeth, which holds the lower jaw a little more down and forward from its usual relaxed position. When in use the users tongue is moved farther from the back of the airways, possibly far enough so that some OSA sufferers are able to gain improved breathing.

When such methods fail to make enough of a beneficial impression GP’s will often suggest the use of continuous positive airway pressure (CPAP).

CPAP comes in the form of a mask attached to the face which has a tube running from an air pump to the sufferer’s mouth and/ or nose, forcing controlled bursts of air through the obstructed air passageways and into the lungs. CPAP uses a constant air pressure found by performing an overnight test or ‘titration’ on the sufferer. Recent models of CPAP contraptions are able to reduce the exhalation pressure for improved performance and patient comfort.

Variable positive airway pressure (VPAP), known also as bilevel or BiPAP, monitors the patients breathing with an electronic circuit. Two different pressures are adopted here, inhalation has a higher pressure than exhalation. This system is more expensive than CPAP and is often used on people that have other respiratory problems or who find sleeping with higher exhaling pressures from CPAP difficult.

Automatic positive airway pressure (APAP) uses sensors that measure air pressure in conjunction with a computer that monitors the patient’s performance with breathing. Pressures exerted by the air pump are constantly adjusted, i.e. heightened when the user is finding breathing difficult, lowered when pressures are considered higher than necessary.

Various surgical ways of widening airways, or removing or tightening tissues in that area are used, the success rate tends to be low with these practices. In some cases patients adopt a combination of such therapies to reduce their OSA. Surgery is typically a last resort, used when none of the above, as well as other more experimental OSA reduction methods (e.g. pharmaceuticals like methylxanthine theophylline and modafinil, and neurostimulation e.g. pacemaker stimulation), have been deemed effective.

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OSAS can be due to an obstruction of a persons airways. When asleep peoples muscles relax, some to the point where, due to a particular set of physical characteristics, an airway is sufficiently reduced in size to allow habitual blocking. One of the commonest causes can be a deviated septum.

The septum is the wall of flesh and bone that separates each nostrils chamber. Whether due to an accident or genetic defect/ similar this part of the body can be altered with modern surgical techniques, if other techniques fail (e.g. nasal strips), to alleviate the nostril blockages. Narrowings of the nasal cavity potentially threaten the draining of the mucus from the sinuses. Infections can result from drastic build-up of waste matter in the nasal cavity, further restricting airflow. Allergic rhinitis, e.g. hay fever, can also obstruct the nasal air passages through tissue swellings.

Electrosurgical probes or lasers can be used by trained surgeons to literally burn enlarged areas of obstructing skin within the nose away, typically an office procedure. This surgery is usually directed at the surface tissue or underlying tissue (sub-mucosa). Recovery of the nose tissue when the surface was operated on tends to take 3 or more weeks. If sub-mucosal surgery was adopted the recovery is generally shorter, at around 10 days maximum.

The cartilage or bone in the nose can be broken and left to set in its new and usually more natural position. If the source of the obstruction was the thickening of nose tissue the moved tissue/ bone often returns to its original position unfortunately.

Surgical scissors or the use of a laser can remove just the flesh around the septum (turbinate excision), or the bone as well (turbinate resection). After this type of surgery a gauze soaked with antibiotics is placed in the nostrils about the surgery area for several days to prevent infection.

Of the potential complications that can occur with surgery such as this, over bleeding may result if the nose is not packed with enough sterile absorptive material. This is generally a potential problem with turbinate resections. Resections of the turbinate can also possibly end with the tissues being irreversibly dried out through too many of the blood supplying vessels having been damaged. General healing of the nose, often involving the accumulation of dried blood blocking the airways, can take longer than expected e.g. 4-6 weeks.

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Ideally people undergoing surgery to reduce sleep apnea should be below 60 years of age, not overweight, have a moderate to mild OSA severity (i.e. a respiratory disturbance index (RDI) of less than 30) and have an oropharyngeal (easier to operate regions of the palate, tonsils or uvula) instead of hypopharyngeal obstruction (more difficult to treat region of the head centered around the tongue base and hypopharyngeal structures).

Two (from a range of surgical treatment options) significant surgical sleep apnea operations are now detailed.

Nasal surgery

OSA sufferers commonly complain of obstructions within their own nose airways. Blockages may be from a collapsed or very narrow nasal valve. Surgery on the nose has been found to be very successful at furthering breathing, decreasing the turbinate size, enlarging the nasal valve or correcting deviations in the septum.

Mid to high severity OSA sufferers have been found to require more than nose surgery to alleviate their breathing problems. Nasal surgery can often be done to aid someone’s used of continuous positive airway pressure (CPAP) therapy.

Taking around one hour to complete, nasal surgery is conducted under general anaesthesia. When the patient awakens only a slight discomfort tends to be felt, easily controlled with a few medications over a couple of days. Sometimes modified areas require structural support in the form of small pieces of sponge that are placed deep inside temporarily. Although potentially slightly uncomfortable and requiring removal at a later date, this method is not always required or used.

Rare infections or heavy bleeding have been the commonest of possible associated complications.

Radiofrequency surgery

Radiowaves are used to decrease the volume of soft tissues in the nasal turbinates, tongue or soft palate. This surgical technique is accurate and uses temperatures of 60-90 degrees celcius, limited to the are being operated on.

Local anaesthetics are injected into the areas to be modified, treatment probes that release the high energy radiowaves then getting inserted where the tissue requires reduction. Only small levels of discomfort are generally experienced during and after this procedure.

Healing tends to take 1-3 weeks. Scar tissue that then ensues actually shrinks the tissue which helps enlarge the airways.

Nasal turbinates are operated on in around 15 minutes. After the operation people are generally able to immediately resume their normal activities without any hindrance’s. A low level of nasal stiffening is all that may be felt for 3-5 days after the surgery.

Reducing the volume of the tongue tends to take around 20 minutes, again involving low levels of discomfort. Complications that have been known to occur are infections and strong swellings. Since these complications are increased with time spent receiving radiotherapy multiple sessions of treatments are generally conducted.

Soft palate reduction is largely only beneficial to people suffering from low to mid levels of sleep apnea. Radiowaves stiffen the problem tissue therefore enlarging the airways. Local anaesthesia via injection is used, the operation takes on average 10 minutes to complete with minimal discomfort. After the operation the patient tends to be able to engage in all their usual activities. For around 2-3 days swallowing and sleeping may be slightly more difficult than usual since the swelling of the soft palate will at first be a noticeable obstruction.

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What may well be happening is a condition known as sleep apnea. When people sleep they undergo many cycles, five stages in all can be moved through per sleep cycle. Initial stages consist of drowsiness and light sleep, latter deep sleep stages then result, REM being the final state.

Sleep apnea involves your body physically stopping breathing for a very short amount of time. Your body reacts to this sudden starving of oxygen by jolting you into commencing breathing again. Afterwards sleep is continued, unfortunately time is required to reach deep sleep and therefore people who’s bodies are constantly waking up during a night may well find they’re very tired the next day. The incidents when you awoke during the night may well not even be remembered at all. Incidents of breathing cessation can occur many times, sometimes up to 100 times in one night.

Three classifications of sleep apnea exist:

Obstructive Sleep Apnea (OSA)

By far the most common of the sleep apnea’s, people suffering from OSA have normal breathing that becomes momentarily stopped from passing into the lungs due to upper reaches of the air passages (run from the mouth to the lungs and are supported by muscles) collapsing whilst asleep.

Central Sleep Apnea

Chest muscles stop functioning for short periods whilst asleep, breathing consequently momentarily halted.

Mixed Sleep Apnea

Known to be one of the most difficult of the sleep apnea’s to treat. The sufferers brain occasionally fails to keep the body breathing. When the person then tries to breathe an air passage obstruction/ collapse makes this very difficult.

Unusually large tongues, tonsils or uvulas can block your airways. Certain air passage or jaw shapes including polyps found in the nasal cavity can also promote obstructions to air movements. Too much fat deposition around the neck can mean air passages are constricted further when pressure is applied from lying down and sleeping.

Quick re-starting of your breathing increases the work the heart has to do as well. The heart is furiously trying to move what oxygen exists in the blood to all necessary areas. Sleep apnea are associated with:

Strokes
Heart disease
Irregular heart beats
High blood pressures
Heart attacks
Impotence

Sleep apnea is commonest in men, of which those that are older, snore or are overweight suffer most. The huge problem of this condition is that it can go undiscovered for years since it is not immediately obvious. Many sufferers of this condition learn to work around their daily tiredness, how tired they actually are not always being fully realized. Sleep apnea symptoms can be:

Chest retraction (known as sunken chest). Seen in child sufferers
Sore/ dry throat
Low memory
Poor concentration
Lowered libido
Occasional nightly urination
Waking numerous times per night
Depression
Morning dry mouth
Fatigue and sleepiness during the day
Changes in personality
Headaches in the morning
Unexplained respiratory or heart cessations
Strong perspiration during sleep
Increased weight gain

If you or your spouse may have experienced any of the above symptoms try visiting your local GP for answers. Potentially finding that you do have sleep apnea and subsequently getting rid of it could be one of the best things you do.

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