SNORING, OBSTRUCTIVE SLEEP APNEA, AND SURGERY - 07/09/11

Doi : 10.1016/S0025-7125(05)70089-4

Steven W. Barthel, MD ^{^{*
Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, Ohio}}, Marshall Strome, MD, MS, FACS ^{^{*
Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, Ohio}}

Résumé

Snoring is a common condition affecting up to 60% of the adult population with significant physical and social consequences.^{95 Waller P.C., Bhopal R.S. Is snoring a cause of vascular disease? Lancet 1989 ; 1 : 143-146 [cross-ref]

Cliquez ici pour aller à la section Références} Nearly all patients with obstructive sleep apnea (OSA) snore, and a significant number of patients who snore may suffer from OSA. OSA has been recognized as a prevalent and important cause of sleep disturbance with dire physical and social consequences if untreated. OSA is characterized by episodes of apnea and hypopnea during sleep. Apnea is defined as cessation of air flow for 10 or more seconds. When respiratory effort remains, the apnea is termed obstructive. Hypopnea refers to a greater than 50% reduction in air flow.^{20 Fredrickson P.A., Krueger B.R. Insomnia associated with specific polysomnographic findings Principles and Practice of Sleep Medicine, ed 2 Philadelphia: WB Saunders (1994).
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Cliquez ici pour aller à la section Références} OSA syndrome is defined by episodes of obstructive apneas and hypopneas accompanied by daytime somnolence, altered cardiovascular function, or both, resulting from the respiratory dysfunction.^{27 Obstructive Sleep Apnea Syndrome: Clinical Research and Treatment New York: Raven Press (1990).
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Cliquez ici pour aller à la section Références} Minimal criteria for the number of apneas or hypopneas per hour have varied among authors. Currently, more than five apneas or hypopneas per hour is used, most commonly, as minimal criteria for OSA syndrome and is reported as apnea-hypopnea index (AHI). OSA is considered mild if the AHI is 6 to 20, moderate if the AHI is 21 to 50, and severe if the AHI is more than 50.

The prevalence of OSA syndrome in the middle-aged work force is approximately 4% of men and 2% of women.^{103 Young T., Palta M., Dempsey J. , et al. The occurrence of sleep-disordered breathing among middle-aged adults N Engl J Med 1993 ; 328 : 1230-1235 [cross-ref]

Cliquez ici pour aller à la section Références} In the elderly, estimates range from 28% to 67% in men and 20% to 54% in women.^{2 Ancoli-Israel S. Epidemiology of sleep disorders Clin Geriatr Med 1989 ; 5 : 347-362

Cliquez ici pour aller à la section Références, 24 Gislason T., Almqvist M., Eriksson G. , et al. Prevalence of sleep apnea syndrome amoung Swedish men—an epidemiological study J Clin Epidemiol 1988 ; 41 : 571-576 [cross-ref]

Cliquez ici pour aller à la section Références, 46 Lauie P. Incidence of sleep apnea in a presumably healthy working population: A significant relationship with excessive daytime sleepiness Sleep 1983 ; 6 : 312-318

Cliquez ici pour aller à la section Références, 60 Peter J.H., Fuchs E., Kohler U. , et al. Studies in the prevalence of sleep anpea activity: Evaluation of ambulatory screening results Eur J Respir Dis 1986 ; 146 (suppl) : 451-458

Cliquez ici pour aller à la section Références, 72 Schmidt-Nowara W.W., Jennum P. Epidemiology of sleep apnea Obstructive Sleep Apnea Syndrome: Clinical Research and Treatment New York: Raven Press (1990).
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Cliquez ici pour aller à la section Références} The prevalence of OSA syndrome in commercial truck drivers has been reported to be as high as 46%.^{87 Stoohs R.A., Bingham L.A., Itoi A. , et al. Sleep and sleep-disordered breathing in commercial long-haul truck drivers Chest 1995 ; 107 : 1275-1282 [cross-ref]

Cliquez ici pour aller à la section Références} In 1993, the National Commission on Sleep Disorders Research estimated that 18 million Americans suffer from OSA syndrome.^{54 National Commission on Sleep Disorders Research Wake up America: A national sleep alert Washington, DC: Government Printing Office (1993).

Cliquez ici pour aller à la section Références} In addition to being prevalent, OSA syndrome is now considered to be a major public health concern.^{61 Phillipson E.A. Sleep apnea—a major public health problem N Engl J Med 1993 ; 328 : 1271-1273 [cross-ref]

Cliquez ici pour aller à la section Références} In patients with an apnea index greater that 20, the cumulative 8-year mortality of untreated OSA was 37% as compared to 4% for those with an index at or below 20.^{31 He J., Kryger M.H., Zorick F.J. , et al. Mortality and apnea index in obstructive sleep apnea: Experience in 385 male patients Chest 1988 ; 94 : 9-14 [cross-ref]

Cliquez ici pour aller à la section Références} This increased mortality is likely attributable to increased cardiovascular morbidity, including myocardial infarction, dysrhythmias, and stroke,^{55 Palomaki H., Partinen M., Erkinjuntti J. , et al. Snoring, sleep apnea syndrome, and stroke Neurology 1992 ; 42 (suppl 6) : 75-82

Cliquez ici pour aller à la section Références, 56 Partinen M., Guilleminault C. Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients Chest 1990 ; 97 : 27-32 [cross-ref]

Cliquez ici pour aller à la section Références} and traffic accidents.^{17 Findley L.J., Unverzagt M.E., Suratt P.M. Automobile accidents involving patients with obstructive sleep apnea Am Rev Respir Dis 1988 ; 138 : 337-340

Cliquez ici pour aller à la section Références, 88 Stoohs R.A., Guilleminault C., Itoi A. , et al. Traffic accidents in commercial long-haul truck drivers: The influence of sleep-disordered breathing and obesity Sleep 1994 ; 17 : 619-623

Cliquez ici pour aller à la section Références} Additionally, OSA has been identified as an independent contributor to the development of hypertension.^{7 Carlson J.T., Hedner J.A., Ejnell H. , et al. High prevalence of hypertension in sleep apnea patients independent of obesity Am J Respir Crit Care Med 1994 ; 150 : 72-77

Cliquez ici pour aller à la section Références, 34 Hoffstein V., Chan C.K., Slutsky A.S. Sleep apnea and systemic hypertension: A causal association review Am J Med 1991 ; 91 : 190-196 [cross-ref]

Cliquez ici pour aller à la section Références} OSA may be responsible for 38,000 cardiovascular deaths per year, and the cost of OSA is approximately $42 million annually from hospitalization alone.^{54 National Commission on Sleep Disorders Research Wake up America: A national sleep alert Washington, DC: Government Printing Office (1993).

Cliquez ici pour aller à la section Références} Especially concerning are that as many as 95% of OSA patients may be undiagnosed.^{54 National Commission on Sleep Disorders Research Wake up America: A national sleep alert Washington, DC: Government Printing Office (1993).

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Plan

Nonsurgical Treatment

Surgical Treatment

SURGERY FOR SNORING

SUMMARY

Address reprint requests to Marshall Strome, MD, MS, FACS, Otolaryngology Desk A71, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195-0001