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Objective
Assessment of Snoring Before and After Laser-Assisted Uvulopalaplasty |
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The Somnoplasty Procedure | |
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Injection Snoreplasty | |
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Doctor
Makes Snore Losers Happy (Chicago Tribune Article) |
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Evaluation and Testing Dr. Gatti's Approach to Sleep-Disordered Breathing Problems |
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General Information The National Center on Sleep Disorders estimates that over 50 million American adults snore. 1 in 4 snore habitually (every night). 45% snore occasionally. Anywhere from 10% to 30% of those who habitually snore have sleep apnea. The exact number of sleep apneics in this country is hard to quantify, but the proportion of the population who suffers from it is substantial -- some reports indicate 10 million or more of the population. The medical consequences of sleep-disordered breathing are receiving more and more attention in the press and medical literature. Recent studies have shown that even mild snoring can be associated with hypertension, strokes, and heart trouble. Correlations between obesity, hypertension, and snoring have also been reported. "Habitual snoring should signal the patient to be alert to an underlying and more serious condition called sleep apnea, much as angina (chest pain) may be an early warning signal of heart attack." Some Factors To Look For In Sleep-Disordered Breathing Problems When a patient enters my office with a sleep-disorder problem, I generally approach the initial evaluation with three factors in mind which may be the cause of the difficulty. One of these factors, or any combination of them, may be responsible for the patient's symptoms. These factors are not exclusive but in general they are responsible for a very large percentage of sleep-disorder problems. The three factors are:
Examples of nasal obstruction include fractured nose and/or deviated nasal septal cartilage (it is estimated that 20% of the U.S. population have a deviated septum), allergic rhinitis (it is estimated that 17% of the U.S. population have allergic rhinitis), and turbinate hypertrophy to mention the more common types. Surgical procedures to correct these problems include septoplasty, nasal polypectomy, endoscopic sinus surgery, and turbinate reduction procedures (LATR). Medicines/allergy shots for strict allergy control are also essential to keep the nasal airway clear. Examples of masses or tissues compromising the airway include tonsil and/or adenoid enlargement, large tongue base, elongated "floppy" and/or thick uvula and low draped "floppy" soft palate. Weight gain only helps to magnify these conditions. Surgical procedures to correct these problems include tonsillectomy and adenoidectomy, laser-assisted uvulopalatoplasty (LAUP), somnoplasty, injection snoreplasty (new), uvulopalatopharyngoplasty (UPPP), and base of tongue submucosal radiowave techniques (new). Throat muscle weakness may occur with age or the throat muscles may be naturally or artificially and temporarily lax (alcohol before bedtime) causing drift of the muscles inward when we sleep. In some patients the "resting tension" normally present in throat muscles at night which would help to keep the the airway "rigid", is lacking therefore, compromising the nightly airway. Continuous Positive Airway Pressure (CPAP) treatment may be the best treatment for this condition. The ENT Exam and Sleep Testing The ear, nose and throat exam begins in a methodical and comprehensive manner. First, a thorough exam of the nose and nasopharynx (behind the nose) is performed. This is followed by an oral exam of the back of the throat and roof of the mouth. The base of the tongue and larynx (voice box) is examined with a mirror held at the back of the mouth. Next, a small fiberoptic instrument with a magnifier and light source is passed through the nose after a nasal spray is used to numb the nasal passage. There is no pain with this procedure, and gagging is minimal or nonexistent. Most patients describe the experience as "weird" or "different." The patient is then asked to perform a Mueller maneuver. Patient instructions in this maneuver result in reverse breathing attempts with mouth and nose closed and with fiberoptic scope in place to determine where throat muscle weakness may be present. Based on these fiberoptic results, the choice of treatments can be more confidently recommended. After the ENT exam, a SNAP home sleep test or, in some cases, an overnight sleep study in a hospital might be recommended. The main advantage of SNAP home testing in my practice is that it not only detects the presence and degree of sleep apnea, but also helps locate the site of snore production. Therefore, a uvulopalatal procedure, if needed, may be more confidently and objectively recommended. Sleep Apnea In sleep apnea the airway becomes completely blocked at intervals thoughout the night. Sleep apnea is defined as cessation of breathing occurring for 10 seconds or more, 7 or more times per hour. Based on the frequency and duration of these events, sleep apnea can be classified as mild, moderate, or severe. Sleep apnea has been linked to a wide variety of symptoms, medical conditions, and other consequences. These include tiredness and lethargy during the day, frequent headaches, mood swings and irritability, shortened attention span, memory loss, sexual dysfunction, depression, weight gain, high blood pressure, hallucinations and confusion, loss of judgment, strokes, and cardiac problems along with car, truck, train, and bus accidents. It is estimated that 1 in 7 auto accidents in the U.S. occur from people falling asleep at the wheel. Summary Accurate assessment of sleep-disordered breathing problems is the key to successful treatment and cure. Recommended treatment, whether it be nightly continuous positive airway pressure (CPAP), uvulopalatal procedures, nasal surgery, or more extensive palate-jaw-tongue surgery, is predicated on a thorough ear, nose, and throat exam and testing procedures. Testing and Analysis - SNAP Laboratories SNAP Laboratories of Glenview, Illinois is responsible for developing an acoustical analysis system that helps locate the source of snoring and detect sleep apnea conditions. SNAP Laboratories is considered to be the largest sleep center in the world, performing far more diagnostic tests monthly than the average sleep center performs in a year. SNAP testing is currently the most cost effective test for apnea detection and at the present time the only available method of analyzing snoring and specifically identifying palatal snoring. Our office uses the SNAP testing system in diagnosing your condition. Dr. Gatti can then use data from the SNAP test along with clinical information and examination to select the most appropriate form of therapy for your snoring and/or sleep apnea problem. This therapy may include Injection Snoreplasty, Laser Assisted Uvula Palatoplasty (LAUP), Somnoplasty, Uvulopharyngopalatoplasty (UPPP), or continuous positive airway pressure (CPAP). SNAP Laboratories will assist you in insurance reimbursement for this test. All questions regarding insurance should be directed to SNAP Laboratories. Polysomnogram is another option our office provides, available for apnea screening, performed either in a hospital or at home. A cost comparison follows:
Patient instruction and guidelines are provided by a trained staff person at Dr. Gatti's office. The test is performed in the patient's home. The subject places a proprietary device below the nostrils which collects four or more hours of oro-nasal respiratory sound and airflow information which is digitally recorded. Another sensor is placed on the finger to collect oxygen data. Data recorded during sleep is returned to the doctor's office the following day for lab processing and analysis yielding the following information:
Disclaimer: Dr. Gatti is a medical advisor to SNAP Labs. He is fully aware of other diagnostic testing to detect sleep apnea/snoring; that there are no other diagnostic tools yet available which can duplicate the accuracy of the SNAP test in its unique ability to analyze snoring patterns including their magnitude and vibrations along with palatal localization as well as detecting the frequency, duration, and degree of sleep apnea.
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