University of Pennsylvania Health System

Penn Health and Wellness

Monday, July 25, 2011

Sleep Apnea: “Why am I so Tired?”


Sleep apnea, interrupted breathing while sleeping, has been linked to hypertension, heart disease, elevated blood sugar and stroke. There are a variety of diagnostic and treatment options available to treat sleep apnea and help sufferers regain a good night’s sleep. Penn is pioneering one of the latest options, which uses minimally invasive robotic surgery to treat sleep apnea patients who have problems with excess tissue at the base of the tongue.

Sleep apnea tends to be more common in men, and the bed partner often has sleep issues because of the snoring or gasping. In fact, it is often the wife who nudges her husband to seek treatment for this disorder, according to Ronald Barnett, MD, pulmonologist and sleep medicine specialist at Penn Medicine Valley Forge.

Grace Pien, MD, a specialist in women’s sleep issues, says a woman’s risk of developing sleep apnea increases after menopause. Dr. Pien is currently studying the role of estrogen and other reproductive hormones in protecting women from sleep apnea.

“Women appear to be protected from sleep apnea during their child-bearing years, but the risk increases once they enter perimenopause, and the risk for post-menopausal women is three times greater compared to premenopausal women,” said Dr. Pien.

A thorough sleep evaluation reviews all aspects of a person’s sleep habits, physical characteristics and associated medical conditions to help physicians make a diagnosis of sleep apnea. Usually, patients undergo an overnight sleep study, which can be performed in a sleep laboratory, or increasingly, in patients’ homes using home sleep monitors. About 80 percent of people tested are diagnosed with sleep apnea, according to Dr. Barnett.

Sleep studies are often recommended for patients who are overweight and have a history of hypertension and cardiac arrhythmias because of the link between sleep apnea and heart disease, according to Theodhor Diamanti, MD, Penn cardiologist. “Sleep apnea causes the oxygen levels to drop and low oxygen levels can lead to life-threatening cardiac arrhythmias,” said Dr. Diamanti.

Patients treated for sleep apnea are better rested, have higher oxygen levels, and are more active and able to live healthier lives.

The most common, and most successful treatment for sleep apnea is CPAP — continuous positive airway pressure. The positive airflow blows into the nose and/or mouth and keeps the airway open so that breathing is not interrupted. The treatment works for about 90 percent of patients.

Continuous positive airway pressure (CPAP) helps many patients who suffer from sleep apnea. But for those patients who can’t tolerate CPAP, surgery – including minimally invasive robotic surgery — may help break the sleep apnea cycle.

The muscles that hold the airway open relax during sleep. When the loose tissue vibrates, someone snores. If the tissue in the back of the throat collapses, it blocks the airway and results in sleep apnea. Uvulopalatopharyngoplasty is the most common procedure for removing the excess tissue in the throat.

“In surgical management of sleep apnea we can remove the tonsils and trim the uvula and palate,” said Erica Thaler, MD, Penn otorhinolaryngologist. “Now with the introduction of transoral robotic surgery (TORS) we can also help patients who have issues with the tissue at the base of the tongue.”

Dr. Thaler said about 20 patients have been treated for sleep apnea using TORS with good results. “This is a new procedure so we are continuing to follow these patients through sleep studies,” Dr. Thaler said, “but so far our outcomes have been positive.”

To learn more about transoral robotic surgery (TORS), visit the Department of Otorhinolaryngology-Head and Neck Surgery. To schedule an appointment, please call 800-789-PENN (7366).

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