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Trends in Management of Snoring Deepak Gupta Department of Otolaryngology The Great Western Hospital & The Ridgeway Hospital Swindon.

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Presentation on theme: "Trends in Management of Snoring Deepak Gupta Department of Otolaryngology The Great Western Hospital & The Ridgeway Hospital Swindon."— Presentation transcript:

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2 Trends in Management of Snoring Deepak Gupta Department of Otolaryngology The Great Western Hospital & The Ridgeway Hospital Swindon

3 Snoring Definition: Rough, noisy breathing during sleep, due to vibration of uvula and soft palate, maybe tongue Mechanism: Obstructive air flow leading to turbulence which vibrates soft tissue in the mouth and throat to produce sound. Incidence: Men 24% - 50%, women 14% -30%

4 Sleep-Disordered Breathing (SDB) Simple Snoring Upper Airway Resistance Syndrome (UARS) Mild Obstructive Sleep Apnea Syndrome (OSAS) Severe Obstructive Sleep Apnea Syndrome (OSAS)

5 Collapsible Portions of Upper Airway

6 Consequence of Snoring Social – the sound of Snoring may lead to marital disharmony or social embarrassment Sleep disturbance and fragmentation lead to excessive daytime sleepiness e.g. traffic accidents Sore throat

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8 Quantifying Snoring Frequency Position sensitivity Witnessed apnoeic episodes Duration Degree of disruption

9 Clinical Assessment Obesity – Neck Circumference Alcohol Smoking Daytime Sleepiness Witnessed Apnoeas Abnormal nocturnal motor activity Other nocturnal events Epworth

10 Clinical Examination Body Mass Index (BMI)/Neck Nasal Obstruction Oral cavity/Oropharynx Laryngoscopy

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13 Signs/Symptoms of Sleep Apnea Breathing sounds during sleep Excessive daytime sleepiness Fatigue Changes in alertness, memory, personality Hypertension/CHF Impotence Headaches Bedwetting

14 Assessment of Sleep Apnea Epworth Sleepiness Scale Nocturnal oxygen saturation Home sleep testing -Apneagram Polysomnography

15 Epworth Sleepiness Scale 0-24 Sitting and reading Watching TV Sitting inactive in a public place As a passenger in a car for an hour Resting in the afternoon Sitting and talking to someone Sitting after lunch without alcohol In a car while stopping for a few minutes in traffic Chance of dozing 0=never 1=Slight 2=moderate 3=High

16 How to assess the region of obstructions To determine a surgical procedure it is valuable to know the location of the nocturnal obstruction.

17 Deciding on a Treatment Option

18 General Treatment for SDB Control of body weight Behavioral modification avoid full dinner and excess alcohol sleep in lateral or prone position

19 Patient Administered Treatments Worth a Fortune!

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24 Oral Appliances Mandibular repositioning devices(MRD) Tongue retaining devices

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26 MRD Good compliance Reduce frequency, intensity and duration of snoring Xerostomia TMJ pain Dental pain Myofacial pain Bite change

27 Nasal CPAP Very effective Low compliance when used for snoring alone 70% prefer less effective MRD

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29 health/article-81411/Ten- snoring-cures.html health/article-81411/Ten- snoring-cures.html

30 Surgical Interventions Nasal Surgery – poor prediction of success Adenoid/Tonsil Surgery Palatal Surgery 50-95% short term success 45-75% long term success Poor correlation between objective decrease in intensity and subjective improvement Maintenance of fall in snoring volume Tongue base surgery Jaw advancement Hyoid myotomy and suspension Tracheostomy

31 Why should we operate May be the only tolerable option Only ‘permanent’ option Good results Mimimal complications

32 Why not to operate Variable success Insufficient evidence base May make future CPAP use difficult Recurrence with time and age

33 Intra Palatal Surgery Diathermy Cold steel Radiofrequency Laser Injection Sclerosis Intra palatal devices Low morbidity LA Out-Patient Procedure Repeatable UPPP still possible SR 30-80% in short term Possible decrease in long term Best for BMI less than 25,Tonsil grade 1 & 2, AHI less than 25

34 Radiofrequency Ablation RFA Snoring, mild/moderate OSAS Interstitial volume reduction and stiffening Local anaesthesia/out patient Day procedure

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40 Anti-snoring device (ASD implants) Pi Medical (Minnesota, USA) Year 2000 Increase stiffness of soft palate Permanent implant

41 Uvulopalatopharyngoplasty * * *

42 Laugh and the world laughs with you snore, and you snore alone - Mark Twain Thank You – and sleep well


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