SNORING AND SLEEP-APNEA SYNDROME - SURGICAL-TREATMENT AND MESAM-IV-CONTROLLED, POSTOPERATIVE RESULTS

Approximately 20 % of the population snore. Snoring is caused by a vibration of oropharyngeal soft tissues during air flow.The anatomical origin of snoring can be the soft palate with a hyperplastic uvula or the region of the base of tongue. An uvulopalatopharyngoplasty (UPPP) as a mode of surgical treatment is only appropriate in the first case. A patient can be considered to be suffering from sleep apnea syndrome if snoring is associated with a temporary complete obstruction of the upper airway with a subsequent decrease in oxygen saturation. In this case continuous positive airway pressure (CPAP) therapy can be beneficial; however, the role of surgery is confined to those operations providing unimpaired nasal air flow. Following extensive preoperative diagnostics, including sleep monitoring with the MESAM-IV-system, 68 patients with palatal snoring underwent surgery. 46 could be examined 6 to 8 months postoperatively: In 41 patients snoring disappeared completely or was reduced to a few occasional episodes. 5 patients continued to snore after the UPPP. These patients were obese at the time of surgery and a preoperative attempt to lose weight was only partially successful. Although we identified the soft palate as the probable cause of snoring by fiberoptic examination, especially the overweight patients bear the risk of additional narrow segments in the region of the base of the tongue. The appropriate weight loss is therefore a fundamental prerequisite for successful treatment. 5 patients with sleep apnea syndrome combined with nasal obstruction underwent septum, turbinate and sinus surgery to create unobstructed nasal airflow. The following CPAP treatment was of great benefit to them. With these MESAM-IV-controlled postoperative results we were able to demonstrate that the UPPP, combined with nasal surgery if necessary, is a successful treatment of palatal snoring.