Snoring is a very common problem. At least 45% of normal adults snore occasionally and 25% snore every night. It is more common in males and persons who are overweight. Snoring also tends to worsen with age.
Most people are unaware that they snore; it is often brought to their attention by a sleepless bed partner. Many couples have been sleeping separately for years so that at least one of them can get a full night’s sleep. Besides loneliness, a poor night’s sleep can lead to decreased job performance and hazardous driving.
Snoring can also be a sign of more serious problems. When loud snoring becomes associated with frequent episodes of totally obstructed breathing, then the snorer may be experiencing obstructive sleep apnea (OSA). If left untreated, this condition may lead to high blood pressure, heart and lung disease, and stroke. An overnight sleep study, performed either at home or in a sleep laboratory, is usually required to make a diagnosis of OSA.
Snoring can be caused by obstruction in the nose, mouth or both. The loud and irritating noise associated with snoring occurs when there is an obstruction to the free flow of air in the nose or in the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. As these structures contact each other and vibrate when taking a breath, the snoring sound is created.
The key to improving snoring is to lessen the impact that nasal or oral obstruction has on the free flow of air through the nose and/or mouth while sleeping. This can be achieved through medical or surgical intervention. Sustained weight loss and avoidance of sedatives can often markedly improve snoring.
Most snorers can benefit greatly from a variety of office-based or same-day surgical procedures which can be tailored to the source and degree of airway obstruction. It is important to correct any significant nasal component of snoring first as this is the natural form of breathing. Nasal obstruction due to enlarged turbinates (finger-like projections which hang off the sidewall of the nasal cavity) can be improved by performing a short outpatient procedure to reduce the bulkiness of tissue with little or no post-operative discomfort. If the nasal septum (the wall which separates the right and left nasal cavity) is blocking the airway, then a septoplasty can be performed as well on a same-day surgery basis. Sinus surgery, if required, could also be performed at this time.
Once the nasal component of snoring, if any, is addressed, then the oral obstruction is improved. This can often be addressed by procedures performed in our office.
The injection snoreplasty is a proven technique that has been developed for treating snoring by injecting a small amount of a medication into the soft palate tissue. The results of the first 30 patients treated were presented at the September 2000 meeting of the academy of Otolaryngology/Head and Neck Surgery. Dr. Bosworth trained with the team that introduced this new procedure. The medication, sotradecol, has been used for many years by vascular surgeons to shrink varicose veins. The new procedure takes advantage of the properties of sotradecol to create a scar within the soft palate tissue. This contracts and stiffens the soft palate, significantly reducing and in many cases, resolving the snoring. The success rates in the first 30 patients that have been treated are greater than ninety percent. A follow-up study published one year later confirmed this success rate. This number should be viewed cautiously however because typically patients with less severe problems that are easier to treat are selected for these initial trials. More recently larger studies have shown a success rate of 77%. This procedure is performed in the office and is associated with mild discomfort afterwards. The procedure typically needs to be repeated one or two times. Further research is being done to assess the effectiveness of this procedure in patients with mild obstructive sleep apnea.
Some patients, particularly those with very thickened soft palates or very long uvulas, may benefit more from a Cautery-Assisted Palatal Stiffening Operation (CAPSO). This technique was also introduced by the team that developed the injection snoreplasty procedure. This technique uses electrocautery to remove a midline portion of soft palate mucosa and uvula. Scar forms which stiffens the soft palate. Thus, palatal snoring significantly improves or resolves. This procedure is also brief and performed in our office as well. Dr. Bosworth has had the opportunity to train with the physicians who developed this technique as well and is one of the only surgeons performing this technique in this area.
We are also very excited about the Pillar Palatal Implant System which produces similar results to the techniques described above with less post-procedure discomfort. Please see our article regarding this technique in this section of our website.
Snoring can last a lifetime but doesn’t have to. A variety of mostly office-based procedures are available to improve a snorer’s lifestyle, both by day and night.
Listed below are some references for additional information.
1:Littlefield P, Mair E. Snoring surgery: Which one is best for you?