DR ARJUN DASGUPTA

Snorers ‘more at risk of heart attack than smokers or obese’

Snorers are more likely to have a heart attack than smokers or the obese, say researchers.Far from being merely a nuisance, snoring could be the early warning sign of life-threatening health problems, they warn.

Around a quarter of women and four in ten men are frequent snorers, although nearly half of us snore occasionally. Though it can interfere with our sleep and that of our partners; it was not thought to cause any long-term health problems until recently. Researchers claim the condition is as serious as having high blood pressure and urge snorers to seek medical advice.

• New connection between ‘plain’ snoring not more severe sleep apnea and cardiovascular risk
• Snorers must seek treatment in the same way as those with high blood pressure or heart disease risk factors

Changes in the carotid artery are a precursor a hardening of the arteries, which can cause heart attacks and brain hemorrhages. So instead of kicking your snoring bed partner out of the room or spending sleepless nights elbowing him or her, seek out medical treatment for the snorer. The researchers found that the innermost layers of the artery walls were far thicker among the snorers than the other adults. People require significant attention rather considering snoring as a cosmetic issue.

We are hoping to change that thinking of patients can get the early treatment they need, before more serious health issues arise. Snoring is more than a bedtime annoyance and it shouldn’t be ignored.Patients need to seek treatment in the same way they would if they had sleep apnea, high blood pressure or other risk factors for cardiovascular disease. The study of 1,500 adults found that moderate snorers were at 4.8 times greater risk of death.

Sleep Apnea and Heart Disease, Stroke

 Plain old snoring can get a little annoying, especially for someone listening to it. But when a snorer repeatedly stops breathing for brief moments, it can lead to cardiovascular problems and potentially be life-threatening. It’s a condition known as sleep apnea, in which the person may experience pauses in breathing five to 30 times per hour or more during sleep. These episodes wake the sleeper as he or she gasps for air. It prevents restful sleep and is associated with high blood pressure, arrhythmia, stroke and heart failure.Heart disease is the leading cause of death across the world, and stroke is the No. 4 cause and a leading cause of disability. High blood pressure is a major risk factor for both. The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease.

A Common Problem
one in five adults suffers from at least mild sleep apnea, and it afflicts more men than women. The most common type is obstructive sleep apnea in which weight on the upper chest and neck contributes to blocking the flow of air. (Another type, called central sleep apnea, is far less prevalent.)Obstructive sleep apnea (OSA) is associated with obesity, which is also a major risk factor for heart disease and stroke. Besides obesity contributing to sleep apnea, sleep deprivation caused by sleep apnea can, in an ongoing unhealthy cycle, lead to further obesity. In OSA the upper airway closes off because the muscles that hold it open lose tone the more weight, the more loss of tone and the more severe the sleep apnea. Each time the airway closes; there is a pause in breathing.

Another type of sleep apnea, called central sleep apnea (CSA), is far less prevalent. In CSA the brain doesn’t send regular signals to the diaphragm to contract and expand. There is limited snoring with CSA, and it has been associated with brain stem stroke because the brain stem is where the impulse to breathe comes from.

 Listen to that Snoring Complaints
often a roommate or sleeping partner of someone with sleep apnea notices it. It’s really hard to detect if you live alone, unless you go through a sleep study, people with sleep apnea may be more tired during the day, and therefore prone to accidents or falling asleep.

 Getting Proper Treatment

Through treatment known as continuous positive airway pressure, or CPAP, is well proved method. The CPAP device involves wearing a mask while sleeping.It keeps air pressure in the breathing passages so they don’t close down. Some patients have bad reactions to the masks, but the design has evolved significantly, making it easier to find a suitable one.In a sleep study, doctors count pauses in breathing to determine whether the patient has mild sleep apnea, characterized by five to 15 episodes per hour; moderate sleep apnea, defined by 15 to 30 per hour; or severe sleep apnea, meaning more than 30 each hour. Unfortunately CPAP may not be well tolerated by some persons.

It’s certainly possible to have simple, loud snoring without sleep apnea. But with regular snoring, the person continues to inhale and exhale.With sleep apnea, the sleeping person tends to have periods when he or she stops breathing and nothing can be heard. The good news is treatment that keeps the breathing passages open and oxygen flowing can yield fast results. Blood pressure comes down really quite quickly.

Few more activities are even better; the apnea patients are getting a good night’s sleep with regular physical activity, not right before bed because that will increase the adrenaline pumping and can keep the person awake.Limit alcohol consumption to one drink per day for women and two drinks for men as too much alcohol interferes with sleep. Avoid caffeine before bed is a preventative approach along with pre-bedtime routine such as taking a warm bath, dimming the lights or having some herbal tea.

Surgery – Surgical Procedures for Sleep APNEA

Surgery may be a multi-step process involving more than one procedure. Mainly for people who does not tolerate CPAP very well. Also it may be a first choice for children. It may needed to continue using CPAP even when surgery successfully reduces the severity of sleep apnea. It is important to follow up regularly with the sleep physician after surgery.

Surgical options include:

 Uvulopalatopharyngoplasty (UPPP)

This procedure, and other types of soft palate surgery, targets the back of the roof of your mouth. It involves removing and repositioning excess tissue in the throat to make the airway wider. The surgeon can trim down the soft palate and uvula, remove the tonsils, and reposition some of the muscles of the soft palate. UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. But UPPP alone is unlikely to cure moderate to severe sleep apnea. It may be combined with surgeries that target other sites in the upper airway.

Radiofrequency Volumetric Tissue Reduction (RFVTR)

Radiofrequency ablation is a treatment option for people with mild to moderate sleep apnea. It uses controlled cauterization to shrink and tighten the tissues in and around the throat.  It can be applied to the soft palate, tonsils and tongue.

Septoplasty and Turbinate Reduction

These surgical options open the nasal passage to improve the flow of air. Septoplasty straightens a bent or deviated nasal septum. This is the divider that separates the two sides of the nose. Turbinate reduction reduces or removes the curved structures that stick out from the side of the nose. They can be enlarged for a number of reasons, including allergies. Medications can also help reduce the size of turbinates.

Genioglossus Advancement

During sleep the tongue can fall back to block the space for breathing in your throat. This surgery moves the major tongue attachment forward, opening up space for breathing behind the tongue. It involves making a cut in the lower jaw where the tongue attaches. This piece of bone (but not the entire jaw) is then moved forward.

Hyoid Suspension

This surgery enlarges the space for breathing in the lower part of the throat. The hyoid bone is a U-shaped bone in the neck. The tongue and other structures of the throat like the epiglottis are attached to it. Hyoid suspension involves pulling the hyoid bone forward and securing it in place.

Midline glossectomy and lingualplasty

These two surgeries involve removing part of the back of the tongue. Making the tongue smaller can prevent airway blockage in some people with sleep apnea.Sometimes a special instrument called Coblation is used.

Maxillomandibular osteotomy (MMO) and advancement (MMA)

This type of surgery is a treatment option for severe sleep apnea. It moves your upper and/or lower jaw forward to enlarge the space for breathing in the entire throat. The procedures involve cutting the bone of your jaws, which then heal over the course of months. Your jaws may be wired shut for a few days. Your diet also will be limited for several weeks after the procedure.

Palatal implants

Palatal implants may be effective in some people with snoring or mild sleep apnea.  Small, fiber rods are inserted into the soft palate to stiffen the tissue and prevent airway blockage.