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Snoring + OSAS

Snoring + OSAS

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Snoring + OSAS

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  1. Snoring + OSAS Dave Pothier St Michael’s Hospital 2004

  2. Definition Snoring is noisy breathing during sleep OSAS is upper airway obstruction during sleep

  3. What is it?

  4. Who snores?

  5. How loud? • Kära Walkert from Sweden: 93dB recorded at Örebo Hospital, 24 May 1993

  6. Morbidity • None to patient… • Many reports of shootings and GBH from partners of snorers • Surgery almost entirely done for another’s benefit

  7. Who? Who snores: Facial abnormalities Micrognathia Overweight, thick neck, heavy drinkers Adenoids Who has OSAS: Snorers (end of spectrum) 5% of population 25% of hypertensives 50% of OSAS sufferers are hypertensive

  8. So…NB to differentiate History Examination ??? Investigations

  9. Pickwickian syndrome ‘Fat Boy’ Famous for daytime somnolence

  10. Hx • Weight • Alcohol • Smoking • Nasal symptoms

  11. Epworth score

  12. Examination • Nose • Nasendoscopy • +/- Muller manoeuvre

  13. Investigations • Sleep nasendoscopy • Sleep studies

  14. Treatment of snoring • Conservative • Medical • Surgical

  15. Treatment • Conservative Stop all fun things in life - eating lots - drinking lots of beer - smoking VERY EFFECTIVE IN MOST CASES

  16. Treatment • Medical - over the counter sprays - homeopathy? • Mandibular splints Not good!

  17. Treatment • Surgical OSAS – largely contraindicated Snoring – a myriad of operations

  18. Surgical options for snoring • Nasal • Palatal • Tongue base

  19. Nasal surgery • Septoplasty • SMR • IT’s • Adenoids/tonsils

  20. Tongue base surgery- not commonly perofmed • Advancement procedures • Partial glossectomy • Maxillomandibular advancement

  21. Palatal surgery 1 • Ensure all other causes eliminated • Exclude OSAS • Exclude nasal pathology

  22. Palatal surgery 2 -LAUP -UPPP -Coblation et al

  23. Effectiveness • 80% immediate effect after recovery • 30% at two years

  24. OSAS • Medically treated with CPAP (almost 100% effective) (only 50% compliance)