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Snoring and Obstructive Sleep Apnea:Management


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By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.

Published in: Health & Medicine, Business
  • My partner has probably punched me a hundred times to get me to roll over and stop snoring. I have been using your techniques recently and now my partner has told me that the difference is incredible. But what has amazed me the most is how much better and more energetic I now feel after a good night's sleep! Thank you so much ..really recomended this product
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Snoring and Obstructive Sleep Apnea:Management

  1. 1. Snoring and Sleep Apnea Management Dr.K.O.Paulose FRCS.DLO Consultant ENT Surgeon Jubilee Hospital Trivandrum
  2. 2. About me 2010-Consultant ENT Surgeon Jubilee Hospital, Trivandrum 2004-2010-Consultant ENT Surgeon SUT Hospital, Trivandrum 1987-2003-Consultant ENT Surgeon Bahrain Military Hospital 1978-1987-UK NHS Teaching Hospitals 1973-MBBS Trivandrum Medical College 1980-DLO RCS London UK 1982-FRCS RCS Glasgow UK 35 years of ENT Experience
  3. 3. Kumbhakarna and snoring snoring kumbhakarna.jpg
  4. 4. How Snoring and OSA
  5. 5. Causes of Snoring Nasal Obstruction Enlarged, Uvula, Soft Palate, Tongue Narrow retroplalatal, retrolingual area Enlarged Ts Ads in children Lack of Muscle tone upper airway Air Turbulence in the oropharynx Vibration of soft palate and uvula Venturi Effect-Bernoulli principle
  6. 6. Causes of Snoring
  7. 7. Causes of Snoring -Nasal
  8. 8. About Sleep ApneaWhat is Sleep apnea? Stoppage of breathing while asleep More than 10 seconds 100-500 episode of apneas in one night Plus Hypopneas Cause Hypoxia and HypercarbiaTypes of sleep apnea? Obstructive Sleep Apnea (OSA) Most common-loud snoring Obstruction of upper airway Central Sleep Apnea (CSA) Brain stem lesion, stroke, polio, tumors No snoring Mixed sleep apnea (OSA+CSA) Chronic respiratory failure>central
  9. 9. Signs and symptoms of sleep apnea Choking or gasping during sleep Loud snoring Sudden awakenings to restart breathing Waking up in a sweat during the night Feeling tired in the morning Headaches Daytime sleepiness Lack of concentration,fatigue,irritable Low O2- Brain and Heart
  10. 10. Diagnosis of Sleep Apnea Good History from spouse or parents Physical examination-Nose and Throat Voice recording Flexible Endoscopy CT imaging or MRI retropalatal and pharyngeal airway Sleep study-Polysomnogram-Home Sleep Study Cardiac evaluation
  11. 11. Stop snoring and save your marriage
  12. 12. Day time sleepiness daytime-sleepy.jpg
  13. 13. Broken marriages-Divorce !!!!
  14. 14. Car accidents 8 car crash.jpg
  15. 15. Flexible Endoscopy C:Documents and SettingsAdministrato
  16. 16. CT Scan Retroplatal Airway-PN Ratio CT adenoid and soft palate.JPG
  17. 17. CT Imaging adenoid.JPG
  18. 18. Sagital CT-PN ratio Pharyngeal Narrowing Ratio-Its significance Soft palate-tongue contact and automatically calculated pharyngeal narrowing ratio (PNR), defined as a ratio between the airway cross- section at the hard palate level and the narrowest cross-section from the hard palate to the epiglottis Soft palate should therefore be the target for causal treatment of snoring, LAUP, CAUP, RF somnoplasty all aimed at the soft palate in OSA surgery.
  19. 19. Dynamic Sleep MRI ?
  20. 20. Polysomnography - Sleep lab study Brain electrical activity –EEG ECG Eye and jaw muscle movement Leg muscle movement Airflow Respiratory effort (chest and abdominal excursion) EKG Oxygen saturation
  21. 21. Home Sleep study
  22. 22. Polysomnogram
  23. 23. Treatment of Snoring and Sleep ApneaConservative Weight Loss Avoid Alcohol Dental devices, dilators Avoid sleeping pills or narcotics before bed Stop Smoking Dont sleep on your backSurgical Treatment Glossectomy Mandibular osteotomy Hyod advancement Nasal surgery, Septal surgery,LAPT RF Somnoplasty UPPP-LAUP+Coblator surgery Ts Ads Tracheostomy-last option
  24. 24. Other Non surgical treatment Dental splint Nasal dilator Nasal drops Treatment of allergy CPAP Machine Yoga breathing Tennis ball on pyjama!!!
  25. 25. CPAP CPAP3.jpg
  26. 26. LASER TYPESLaser is an acronym that stands for Light Amplification by Stimulated Emission of Radiation. The first concept of the laser was initiated by Albert Einstein in 1917.CO2 LaserArgon laserThe Nd:YAG (Neodymium:Yttrium-aluminum-garnet)The potassium-titanyl-phosphate (KTP)Diode Laser
  27. 27. Co2 Laser CO2Laser The CO2 laser is the most versatile laser in otolaryngology. The carbon dioxide (CO2) laser emits a colorless, infrared light at a specific wavelength of 10,600 microns, which has an extremely high affinity for the intercellular water of cells. A second, built-in, coaxial helium neon laser is necessary to indicate with its red color the site where the invisible CO2 laser beam will impact the target tissue. This laser, then, acts as an aiming beam for the invisible CO2 laser beam.Advantages of Laser Surgery Fast Painless Bleeding-nil Fast recovery No hospitalization if done under LA GA for difficult casesDisadvantages of Laser Cost of equipment and maintenance Special surgical skills Increased setup time of equipment Need of safety eyewear Increased care for patient safety - explosion or fire hazard. smoke
  28. 28. Laser surgery for snoring and OSA LAUP (Laser Assisted Uvulopalatopharyngoplasty) involves removal of the uvula, shorten the soft palate and reduce the volume of the tonsils using CO2 laser done under-LA / GA LAPT-Laser assisted Partial turbinectomy LAS-Laser assisted Septoplasty LAT-Laser assisted Tonsillectomy
  29. 29. LAUP LA laser sugery4.JPG
  30. 30. LAUP in OPD
  31. 31. After LAUP-LA 12 after operation.jpg
  32. 32. Intubation-GA C:Documents and SettingsAdministrato intubatiC :Documents and SettingsAdministrator
  33. 33. Intubation Contd
  34. 34. Laser surgery under GA
  35. 35. Laser Surgery for OSA in Jubilee
  36. 36. LAUP GA
  37. 37. Tonsils,soft palate and uvula
  38. 38. LAUP and LAPT
  39. 39. LAUP GA
  40. 40. Laser nose
  41. 41. Laser surgery Nose
  42. 42. LAPT -LA
  43. 43. Septal Surgery septoplasty-nisha5.jpg
  44. 44. Post op LAUP
  45. 45. Oldest LAUP
  46. 46. OSA in Children –Ts Ads
  47. 47. Tonsil Adenoid Causing OSA
  48. 48. Tonsillectomy in Children
  49. 49. OSA in Children-Ts Ads Surgery
  50. 50. COBLATOR SURGERYCold Ablation-Coblation Technology a controlled, non-heat driven process — uses radiofrequency energy to excite the electrolytes in a conductive medium, such as saline Temperature 40-70*C-less thermal damage Coblator II, Arthrocare ® USA MachineCoblator Surgery RF turbinate-Turbinoplasty Polypectomy Tonsillothomy-pediatric CAUP –Snoring and OSA Tongue base reduction
  51. 51. Coblator Machine 2coblator machine.JPG
  52. 52. Coblation Technology plasma glow.jpg
  53. 53. CAUP Picture4.jpg
  54. 54. Coblation Surgery IMG_2028.jpg
  55. 55. Coblation Surgery
  56. 56. CAUP GA
  57. 57. Coblation Surgery-GA
  58. 58. Coblation Soft Palate coblator-nisha1.jpg
  59. 59. Coblator stiffening soft palate coblator chaneling soft palate2-nisha3. coblator chaneling soft palate2-nisha3.jpgjpg
  60. 60. Diode laser surgery
  61. 61. Number of OSA Surgery 1980s-UPPP 1996-2003 Laser Surgery-1000+cases (approx) 2004-2010-SUT Hospital- 422 Cases (LAUP+LAPT+LAS+Ts+Ads+CAUP) 2010- Jubilee Hospital-86 cases (LAUP+LAPT+TS+Ads etc) Result-70-80% cure OSA, 80-90% cure Snoring Redo-3-4 cases per year Causes of Failure-Retrognathia, Large Tongue,Obesity,Hypothyroid, Central apnea, Hypotonia, Medications etc
  62. 62. Results of Laser surgery showed the correction of sleep apnea by an average of 70-80% However, the snoring sound reduction was between 80-90%.Side Effects post op infection -rare nasal fluid reflux –temporary nasal regurgitation for few days, but rarely permanent no voice changes were noted Bleeding-rare Dryness of throat-rareCauses of fauilure if any mixed apnea-central component Inadequate excision of tissues-Redo Obesity,alcohol,sedative Lack of muscle tone in the neck Base of tongue factor-coblator reduction Jaw factor-need mandibular advancement
  63. 63. Happily living after
  64. 64. Thank YouFor details please visit my web site: