Sleep disorders specifically obstructive sleep apnoea have been increasingly recognised as a significant health problem in the last two decades.
OSA is a repetative interruption of breathing occurring during sleep.This is due to narrowing or laxity of the of the upper airway(throat) during sleep. This leads to decreased levels o f oxygen in the blood. Several studies have shown that 4% women and 7% men above the age of thirty have moderate to severe OSA. Common symptoms of OSA are disturbed sleep, loud snoring,daytime sleepiness ,morning headache, lethargy, choking sensation in throat and breathlessness.
OSA leading to decreased levels of oxygen in the blood has been shown to increase the risk of cardiovascular diseases, stroke uncontrolled diabetes mellitus and other metabolic disorders.Severe OSA significantly increases the risk of fatal and nonfatal complications of heart diseases.OSA decreases the alertness of a person and gets worsened with daytime sleepiness.Hence , OSA is considered as a leading factor in road traffic accidents.
Considering the common incidence and its association with potentially life threatening diseases the need for early recognition and treatment cannot be over emphasised. Clinical evaluation and Sleep study(polysomnography) are the first steps in this direction.
Medical treatment of OSA is with lifestyle modifications and CPAP (Continuous Positive Airway Pressure) therapy .Life style changes include weight loss, avoidance of alcohol,sedatives and smoking. CPAP is effective and the widely accepted treatment modality . Unfortunately many patients find it difficult to use it every night for a long time . Hence the patient adherence is low(35%). This is especially true in young adults. Also, there are some patients in whom CPAP therapy alone may not be adequate.
. Alternate treatment for this significant group of patients can be done with oral appliances or with specialised surgeries.
Surgeries that were done till a decade ago had only limited success(30%).Fortunately now we have surgical techniques (multilevel procedures) that can address this problem effectively. A sleep endoscopy is done preoperatively to assess the nature of the airway obstruction and to plan the surgical correction . These surgeries are tailor made according to each patient’s level and type of obstruction. Surgeries are minimally invasive or endoscopic procedures and opens up the upper airway or stiffens a laxed one and the success rates are between 65-85%.