Sleep Medicine / Sleep Surgery : Sleep Disorders

Sleep Disorders

Sleep Disordered Breathing

Sleep Disordered Breathing (SDB) refers to a group of respiratory problems that lead to abnormal breathing during sleep. Differences in the severity of of these breathing disorders is determined by the degree of upper airway narrowing and respiratory compromise during these respiratory events. In SBD, the degree of respiratory compromise is determined by whether or not there is a reduction in the flow of air as a result of these events leading to airway obstruction. At the lower end of the spectrum you have patients with primary snoring that despite the social implications associated with it, typically do not experience significant reductions in airflow that lead to oxygen desaturations, frequent arousals, or decreased sleep quality.

Upper Airway Resistance Syndrome

Progression in the scale of airway obstruction from primary snoring is seen in patients who maintain a normal flow of air, but at the expense of increased respiratory effort, which leads to frequent arousals and decreased sleep quality. This is known as Upper Airway Resistance Syndrome (UARS) and it typically leads to symptoms of daytime fatigue, decreased heart rate, and decreased blood pressure. In patients where the airway collapses to the point where the airflow stops completely or significantly enough to cause an arousal or significant drops in the blood oxygen saturation, the problem is termed Obstructive Sleep Apnea (OSA). Patients with this condition typically complain of snoring, daytime fatigue, sleepiness, un-refreshing sleep, choking episodes at night, frequent awakenings during the night, and many other symptoms associated with poor sleep quality. More concerning is the fact that these patients may be at increased risk of high blood pressure, cardiovascular disease, stroke, mood disturbance, poor control of diabetes, obesity, sexual dysfunction, and ocular problems.

Obstructive Sleep Apnea

Obstructive sleep apnea is a problem that starts to develop early in the patient’s life and continues to progress until adulthood. Most children with OSA respond very well to surgical removal of tonsils and adenoids. This is so because pediatric patients have a small airway where any obstructive element such as the tonsils and the adenoids may be enough to cause a blockage that limits the airflow. Despite the proven efficacy of adenotonsillectomy to cure OSA, there are other elements that also need to be addressed early in the patient’s life to reduce the chances of developing OSA later in life as the patient continues to grow and his/her airway continues to develop.