Take Our Sleep Test

In contrast to just feeling tired, how likely are you to doze off or fall asleep in the following situations? (Even if you have not done some of these things recently, try to work out how they would have affected you.) Use the following sleep test scale to choose the most appropriate number for each situation:

0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Your Situation:

Sitting and Reading

Watching Television

Sitting inactive in a public place

As a car passenger for 1 hour, no break

Lying down to rest in the afternoon

Sitting and talking to someone

Sitting quietly after lunch without alcohol

In a car stopped in traffic

    

Research & Publications

Sleep Apnea and Snoring Research and Publications
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Surgical Treatment of Sleep-Related Breathing Disorders

Sesso DM, Powell NB, Riley RW. In:  Kushida CA, ed.  Handbook of Sleep Disorders, 2nd ed.  New York:  Informa Healthcare, 2009:409-429.

Download Handbook of Sleep Disorders - Chapter 32 - Surgical Treatment of Sleep-Related Breathing Disorders

Snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obstructive sleep apnea-hypopnea syndrome (OSAHS) are collectively referred to as sleep-related breathing disorders (SRBD). These terms describe a partial or complete obstruction of the upper airway during sleep. Patency of the pharyngeal airway is maintained by two opposing forces: negative intraluminal pressure and the activity of the upper airway musculature. Anatomical or central neural abnormalities can disrupt this delicate balance and result in compromise of the upper airway. This reduction of airway caliber may cause sleep fragmentation and subsequent behavioral derangements, such as excessive daytime sleepiness (EDS).

The goal of medical and surgical therapy is to alleviate this obstruction and increase airway patency. The first therapeutic modality employed to treat SRBD was surgery. Kuhlo described placement of a tracheotomy tube in an attempt to bypass upper airway obstruction in Pickwickian patients. Although effective, tracheotomy does not address the specific sites of pharyngeal collapse and is not readily accepted by most patients. These sites include the nasal cavity/nasopharynx, oropharynx, and hypopharynx. Often, multilevel obstruction is present. Consequently, the surgical armamentarium has evolved to create techniques that correct the specific anatomical sites of obstruction. To eliminate SRBD, it is necessary to alleviate all levels of obstruction in an organized and safe protocol. The surgeon must counsel the patient regarding all  surgical techniques, risks, complications, and alternative medical therapies prior to intervention. Medical management is often considered the primary treatment of SRBD; however, there are  exceptions.

Treatment may consist of weight loss, avoidance of alcohol and sedating medications, and manipulation of body position during sleep. Currently, continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) devices are the preferred methods of treatment and the standard to which other modalities are compared. The efficacy of CPAP has clearly been  demonstrated, but a subset of patients struggle to comply with or accept CPAP therapy. Patients who are unwilling or unable to comply with medical treatment may be candidates for surgery.