Sleep Apnea & Treatment Advances -- December 6, 2010 -- Dr. Will - | Nashville News, Weather & Sports

Sleep Apnea & Treatment Advances -- December 6, 2010 -- Dr. William Gross


December 6, 2010
Sleep Apnea & Treatment Advances
William Gross, MD: otolaryngologist

NEW TransOral Robotic Surgery (TORS) for Sleep Apnea at MTMC

Obstructive sleep apnea ("sleep apnea") is a disorder where the soft tissues of the throat collapse on inhalation during sleep, causing disruption in the normal breathing process. Sleep apnea can be very problematic as the disruption in a patient's breathing results in decreased oxygen delivery to the body's tissues which in turn can cause long-term damage to vital organs. Moreover, patients can experience significant fatigue from sleep disturbance. This fatigue may create additional problems such as impairment on the job or risk in driving a motor vehicle. Sleep apnea has also been shown to significantly lower life expectancy.

The standard treatment for sleep apnea is to wear a CPAP mask, which improves the opening of the breathing passages by blowing pressurized air into the patient's nose or mouth during inhalation, overcoming the tissue collapse that creates the apnea. Some patients (about 50%) are not able or willing to tolerate the mask. The alternative to CPAP is surgery. Traditionally, surgery has been centered on a procedure known as uvulopalatopharyngoplasty (UPPP), which includes removing the tonsils and trimming the palate. This works about 50-65% of the time to improve the apnea.

It has become clear in the past decade or so that the tissue obstruction also occurs at the base of the tongue in addition to the palate and tonsils. The tongue base obstruction component of sleep apnea may be one of the reasons why surgery on the tonsils and palate alone does not always work.  There have been various supplemental surgical procedures that have been devised to address the tongue base component and improve the success of a UPPP.

At MTMC, Dr. William Gross is pioneering the development of the procedure called TORS to address the tongue base component of sleep apnea. Specifically, identifying surgical candidates who have tongue base level obstruction causing sleep apnea, and applying the TORS procedure to correct tongue base obstruction in addition to palate and tonsil obstruction.

Patients are assessed through in-office examination and review of recent sleep studies, MRI of the neck, and sleep endoscopy – a minor procedure where the patient has sleep induced by an anesthesiologist, and then is evaluated with a scope to identify the levels of tissue obstruction. If the tongue base is involved, then the patient is a candidate for TORS for sleep apnea.

The TORS Sleep Apnea procedure involves the surgery and a 2-3 day post-operative hospitalization. The duration of stay is dependent upon the patient's recovery in terms of pain tolerance and reduction of soft tissue swelling. Full recovery is expected to take about three weeks. A post-surgical sleep study is obtained three months after surgery.

Sleep Apnea

Sleep apnea is a serious sleep disorder that occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain -- and the rest of the body -- may not get enough oxygen.  

There are two types of sleep apnea:

  • Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
  • Central sleep apnea: Unlike OSA, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.


Am I at Risk for Sleep Apnea?

Sleep apnea can affect anyone at any age, even children. Risk factors for sleep apnea include:

  • Male gender
  • Being overweight
  • Being over the age of forty
  • Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
  • Having large tonsils, a large tongue, or a small jaw bone
  • Having a family history of sleep apnea
  • Gastroesophageal reflux, or GERD
  • Nasal obstruction due to a deviated septum, allergies, or sinus problems


What Are the Effects of Sleep Apnea?

If left untreated, sleep apnea can result in a growing number of health problems including:

  • High blood pressure
  • Stroke
  • Heart failure, irregular heart beats, and heart attacks
  • Diabetes
  • Depression
  • Worsening of ADHD 

In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, as well as academic underachievement in children and adolescents.


Sleep Apnea - Symptoms

The most common symptoms of obstructive sleep apnea (OSA) that you may notice include:

  • Excessive daytime sleepiness.
  • Waking with an unrefreshed feeling after sleep, having problems with memory and concentration, feeling tired, and experiencing personality changes.
  • Morning or night headaches. About half of all people with sleep apnea report headaches.2
  • Heartburn or a sour taste in the mouth at night.
  • Swelling of the legs.
  • Getting up during the night to urinate (nocturia).
  • Sweating and chest pain while you are sleeping.

Symptoms of sleep apnea that others may notice include:

  • Episodes of not breathing (apnea), which may occur as few as 5 times an hour (mild apnea) to more than 50 times an hour (severe apnea). How many episodes you have determines how severe your sleep apnea is.
  • Loud snoring. Almost all people who have sleep apnea snore, but not all people who snore have sleep apnea.
  • Restless tossing and turning during sleep.
  • Nighttime choking or gasping spells.
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