15 W. Dry Creek Circle 6169 S. Balsam Way; Suite 290
Littleton, CO 80120-4427 Littleton, Colorado 80123
Phone: (303) 798-1309 Fax: (303) 798-2319
Ear, Nose & Throat Center
Specialists of the Ear, Nose and Throat / Head and Neck Surgery / Facial Plastic Surgery
Evaluation of Dizziness & Vestibular Disorders
For more information see us at our web site ! http://www.ENT Center.Net
OBSTRUCTIVE SLEEP APNEA TREATMENT OPTIONS
A) Some General considerations:
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1) Avoid CNS depressants such as sleeping medications and alcohol-especially prior to bedtime. |
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2) weight loss is beneficial but often difficult in this group of patients. If patients seem unable to lose weight, more aggressive treatment can be pursued. |
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3) Other medications to avoid include barbiturates, narcotics, anesthetics, testosterone, and certain beta blocker antihypertensives. |
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4) Polycythemia may need direct medical attention (e.g. phlebotomy), as may secondary cardiac (e.g. right heart failure) and pulmonary congestion. |
B) Positional sleep apnea occurring primarilv while the patient sleeps in the back position. A simple solution is to ask the patient to attach a tennis ball onto the back of a night shirt between the scapula area. Other mechanical maneuvers may also be tried.
C) Medications:
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1) Protriptyline may have some usefulness in mild forms of sleep apnea. Anticholinergic side effects may contraindicate this medication. |
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2) Thyroid replacement therapy in appropriate clinical situations. |
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3) Medroxyprogesterone acetate has a respiratory stimulant effect. |
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4) Acetazolamide is administered primarily for central sleep apnea. |
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5) Nasal sprays and antihistamines for congestion. |
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6) Oxygen therapy for hypoxia. |
D) Continuous Positive Airway Pressure (CPAP) has been shown to be an effective treatment in 95 % of patients with all degrees of sleep apnea. The machine, however, can be cumbersome to use and long term studies show that in the general patient population only 50 % of patients will continue to use the machine on a regular basis for any period of time. It is also a course of treatment for patients with mild sleep apnea who fail the above therapies. This treatment can eliminate apneas, snoring and the resultant hypersomnolence.
CPAP is a blower which generates 3-20 cm of pressure and is connected to a mask placed over the nose. To accurately determine the pressure for an individual, an all night titration is recommended in the sleep center. Side effects such as mask leakage, nasal/mouth drying, and skin irritation can usually be corrected at the time of titration.
E) Surgeries: are usually performed when indicated for moderate to severe sleep apnea. Most surgical procedures can also eliminate snoring. Surgeries can be highly successful in some patients with a 60% overall cure rate of
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1) Uvulopalatopharyngoplasty (UPPP) involves removing the tonsils, uvula, and soft palate. |
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2) Septoplasty for deviated septums. |
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3) Removal of any other redundant soft tissue (such as polyps) found in the nasal passages. |
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4) Tracheostomy for the most severe refractory cases, or in the setting of life threatening sleep apnea syndromes. |
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5) T&A in children for all degrees of sleep apnea. |
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6) Maxillo-mandibular advancement. |
F) Oral appliances: are worn at night holding the tongue or jaw out of the airway. If clinically indicated, pre and post sleep studies should be obtained to determine the efficacy of treatment. Occasionally, a combination of surgery and medical therapies are needed to eliminate sleep apnea.
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