Severe Sleep Apnea: How to Manage the Condition

What exactly is severe sleep apnea? How is it different from mild to moderate conditions? Most of us know that sleep apnea is one of the worst types of sleep disorders marked by recurrent pauses in breathing. When a person stops in breathing for about 10 seconds 3 to 5 times in an hour, the condition is mild. However, we are told that when the condition is severe, a patient may experience such pauses 5 to 30 times in an hour.

How is severity assessed? 

Since treating sleep apnea is dependent on the severity of the condition, doctors insist on a sleep study, called the polysomnography, before taking any treatment initiative. Polysomnography not only determines the severity of the condition but also the nature of sleep disorder the person is suffering from.  Various physiological and biological parameters are measured during this overnight sleep study that generates substantial amount of data.

One of the most important data from the sleep study is the apnea-hypopnea index, or AHI. The AHI is an index of the severity of sleep apnea, that combines the values of apneas (pauses in breathing) and hypopneas (numbers of shallow breathing episodes). It is calculated by dividing the number of events by the number of hours of sleep. Criteria for evaluation:

–          Mild sleep apnea = AHI between 5 and 15

–          Moderate sleep apnea = AHI between 15 and 30

–          Severe sleep apnea = AHI 30 or more

How is severe sleep apnea treated? 

The primary aim of treating any condition of sleep apnea is to restore normal breathing and allow the patient to experience pause-free breathing in the most effective manner in the shortest possible time. Though positive airway pressure (PAP) is usually the front line therapy for managing moderate to severe conditions, patient compliance often poses a big problem.

Despite its proven efficacy, the actual usage of PAP is only 50%. Discomfort with the nasal/oral mask used during such a therapy is the prime discouraging factor. For the non-compliant patient suffering from severe sleep apnea, surgery is considered to be the most feasible alternative 

Which surgery is the best? 

There are plenty of choices when it concerns surgery for sleep apnea. However, the final choice depends on the site of obstruction which could be anywhere in the upper respiratory tract including the nose, tongue and throat.

What are the different types of surgeries performed?

    1. Tracheotomy till the ‘80s was the only available treatment. It involves making a small incision in the neck and a tube with a valve is inserted through the orifice. While during the day the valve is kept closed enabling the user to speak, at night the valve is opened to keep the airway clear of obstructions. These days, this form of surgery is reserved only for extremely critical cases.
    2. Uvulopalatopharyngoplasty (UPPP): The aim of this surgery is to remove soft tissues from the back of the throat; such tissues could include all or part of the uvula and soft palate. It increases the width of the airway tract, blocks actions of certain muscles and improves movement of the soft palate.
    3. Laser Assisted Uvuloplasty (LAUP) removes the uvula and adjoining tissues to keep the airway open behind the soft palate. Very    effective in curing snoring, its success with sleep apnea is modest.

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