SpecialIssue Surgical Treatment of Snoring and Obstructive Sleep Apnea: ENT Perspective

S noring and Obstructive Sleep Apnea Snoring is a common problem encountered in Thailand. The actual prevalence of snoring in Thailand is unknown, but it is estimated to be about 20% in middleaged male and 5% in middle-aged female in foreign countries. The percentage of elderly people who snore is higher. Most people understand that snoring is normal in daily life, but it actually indicates upper airway obstruction. It is also very annoying to patientsû bed partners as it could deprive them from proper and restful sleep, which is essential to good health. Snoring most often results from collapse of excess soft tissue in the soft palate, tonsillar pillars, tongue, tongue base, and hypopharyngeal walls (Fig 1). If the degree of such an obstruction is severe, it can lead to obstructive sleep apnea (OSA) which is a life-threatening condition. OSA affects about 4% of middle-aged men and 2% of middle-aged women. Snoring and OSA belong to a broad group of breathing abnormalities termed sleep-disordered breathing (SDB). OSA is characterized by periodic collapse of the upper airway during sleep, which leads to either complete (apneas) or partial airway obstruction (hypopneas), or both, resulting in arousal and oxygen desaturation. Risk factors for this condition include obesity, anatomical abnormalities, aging, male gender, and family history. Recognition of OSA is important since it causes daytime somnolence, neurocognitive defects, chronic fatigue, and depression. In addition, it can increase the risk of traffic accident, hypertension, cardiovascular disease, stroke, pulmonary hypertension, and cardiac arrhythmia. From clinical point of view, the most important practical points are: firstly, the differentiation among primary snoring, upper airway resistance syndrome, and OSA; and secondly, the quest for point(s) of airway obstruction. The former can be done by overnight polysomnogram, which remains the gold standard for the diagnosis of OSA. The latter can be achieved by rigid and flexible endoscopy of the upper airway.