Sleep Apnea Nocturnal Hypertension

Is surgery the only option for treating sleep apnea or snoring

I do predominantly the line share of sleep apnea surgery in our department. I collaborate closely with the pulmonologists, who are the sleep medicine s. Those are the s that help diagnose and treat sleep apnea, as well. If those patients fail their, their medical or their conservative therapy, that's typically when they get sent to see me for surgical considerations to, to look at potential cures for their apnea. It's not uncommon for me to see a lot of patients for, who come in for snoring complaints and, you know, are wondering whether or not they have sleep apnea. So sleep apnea is condition where you actually stop breathing at night.

Snoring is somewhere on that spectrum, towards the more mild, you know, milder end of that spectrum. But, you know, really the only way to determine if you have sleep apnea, the gold standard of testing, is really getting a sleep study. And that's an overnight, monitored study where patients, you know, sleep in a room that's similar to a hotel room but they're being monitored and they're hooked up, you know, for sound so to speak with different monitors and cables on them. And that's really our best test to diagnose sleep apnea. The treatment for sleep apnea is typically a nonsurgical therapy; something called CPAP,

which stands for Continuous Positive Airway Pressure. And it's the patients that don't tolerate their CPAP who end up seeing me for surgical considerations. And there's a number of reasons why patients may not tolerate their CPAP. But there are some surgeries that can be helpful in patients who are not tolerant of their medical therapy. And I offer a variety of surgeries including nasal surgery, a variety of palatal surgeries for the kind of tonsil and soft pallet region and then also a variety of tonguebased procedures, as well. But we typically see a patient back after their procedure in about three weeks to recheck everything, make sure that they're healing okay.

After that, I normally recheck a sleep study in about three months after their surgery, just to give everything a chance to heal and to scar. And we, you know, make further recommendations based on the result of their followup sleep study after their surgery. We're exploring the, a new technology now which is actually a nerve stimulator for sleep apnea. It's an implantable device, very similar to a pacemaker that goes into the patient's chest. And there's an electrode that will actually stimulate the nerve that goes to the tongue to provide the tongue with a little bit of more tone when they're sleeping at night, and thereby eliminating their sleep apnea.

Tonsillectomy and Adenoidectomy for OSA Anesthetic Considerations by Denise Chan MD

Tonsillectomy and Adenoidectomy for ObstructiveSleep Apnea: Anesthetic Considerations, by Denise Chan. Hello, my name is Denise Chan, and I'm a pediatricanesthesiologist at Boston Children's . Today, I'll be discussing important aspectsof taking care of children with obstructive sleep apnea syndrome in the perioperativesetting. Introduction. Now, first let's define what is obstructivesleep apnea syndrome. Well, it's a disorder of breathing during sleep, and it's characterizedby a few different things, according to the

American Thoracic Society. First of all, these patients have either prolongedupper airway obstruction, which is known as obstructive hypopnea, or intermittent completeobstruction, known as obstructive sleep apnea. And this occurs with or without snoring. Second, the patient exhibits moderate to severeoxygen desaturation. Third, normal ventilation is disrupted. And fourth, normal sleep patternsare disrupted. So these are the components of obstructive sleep apnea syndrome. Now, in children, obstructive sleep apneasyndrome is oftentimes caused by enlarged

adenoid or tonsillar tissue. And you can seein this illustration that the hypertrophied tonsils really do get in the way of normalairflow. So what do you expect to see in a patientwith this syndromeé First of all, you'll probably see snoring. They'll have difficulty breathingduring sleep, restless sleep, or even nightmares or night terrors. You may see excessive sweating.They may have nocturnal enuresis, or bedwetting, mouth breathing, pauses in breathing, or chronicrhinorrhea. More importantly, though, what is the significanceof having obstructive sleep apnea, and what are the consequences for the patienté Well,there are a number of problems that can occur.

Daytime somnolence patients have fallenasleep while driving older patients, of course and this can lead to motor vehicleaccidents; cognitive dysfunction, which leads to behavioral problems or problems with workor school performance; metabolic effects, such as insulin resistance, type 2 diabetesmellitus, or metabolic syndrome; or other metabolic effects, such as failure to thriveor stunted growth. Or if obstructive sleep apnea is more severeor left untreated, this could lead to cardiovascular morbidity, such as pulmonary or systemic hypertension,cor pulmonale, or stroke. Obstructive sleep apnea syndrome can even lead to death. Andit's been hypothesized to be a factor contributing

to SIDS, or Sudden Infant Death Syndrome.Diagnosis and al Features. In order to diagnose whether or not someonehas obstructive sleep apnea, you must first and foremost perform a thorough history andphysical exam. A sleep history screening for snoring should be a part of every child'sroutine health care visits. It's really unlikely that someone's goingto have obstructive sleep apnea if they don't snore. So if a child does snore, ask the parentsmore details about the sleep history. Does your child have difficulty breathing or stopbreathing during sleepé Or are you worried about their breathing at nighté Does yourchild sweat during sleepé Does your child

have restless sleepé Does he or she breathethrough his mouth while awakeé Has anyone in the family had obstructive sleep apneaor sudden infant death syndromeé Or does your child have behavioral problemsé When you examine the patient, you may noticecertain features that are suggestive of obstructive sleep apnea, such as a small, triangular chin,retrognathia, a high arched palate or a long soft palate, a long oval face, or, of course,large tonsils. There are also certain patients who are athigh risk for having obstructive sleep apnea. And these are patients with obesity; Downsyndrome; PraderWilli syndrome; certain neuromuscular

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