QUESTION 1: What is the difference between sleep apnea and snoring?
ANSWER: In sleep apnea, breathing is interrupted or decreased repeatedly during sleep. Snoring, on the other hand, is an annoying sound due to vibrations in the upper airway without respiratory events.
QUESTION 2: Should snoring be treated?
ANSWER: According to our current information, snoring is not considered a disease. However, there are strong claims that the vibrations caused by snoring damage the muscles and nerves that make up our throat, and this affects the development of apnea. In addition, recent studies have shown that the vibration trauma caused by snoring causes damage to the vessels in the neck.
The treatment is decided by considering the social problems, potential health problems and examination findings of the person who complains about snoring.
QUESTION 3: What are the surgical options in the treatment of snoring?
ANSWER: Often the source of snoring is the vibration of loose tissues in the soft palate. Making the soft palate structure harder and fresher significantly reduces snoring. Radiofrequency application, surgeries that provide tissue reduction from the soft palate or surgeries that change the structure of the soft palate with suture techniques can be applied. Generally, these surgeries are much simpler than interventions for sleep apnea.
QUESTION 4: I have snoring, should I have a sleep test?
ANSWER: One of the main symptoms of sleep apnea is severe snoring. A sleep test is highly recommended if there is persistent and severe snoring.
QUESTION 1: Is sleep apnea seen in childhood?
ANSWER: Yes, it is seen, children who are overweight, have developmental disorders in the facial skeleton and have tonsil-dental meatus problems are in the risk group.
QUESTION 2: What are the symptoms of sleep apnea in children?
ANSWER: The symptoms of sleep apnea differ markedly in children compared to adults. They cause symptoms such as sleep apnea, hyperactivity in children - lack of attention, failure in class, restlessness, bedwetting at night, behavioral and learning disorders, restless sleep at night, night sweats.
QUESTION 3: Will sleep apnea harm my child?
ANSWER: Sleep apnea takes a toll on children. Behavioral-learning disorders and hyperactivity inattention lead to significant lesson failures in these children. Academic achievement in children with sleep apnea is lower than their normal peers. Bedwetting at night, called enuresis, is an important social problem. In addition to all these, children with sleep apnea show growth-development retardation; Lack of healthy sleep is the most important cause of developmental delay. Finally, children with apnea are at risk of heart failure, hypertension, and vascular diseases.
As can be understood from all this information, the treatment of sleep apnea in children is at least as important as in adults.
QUESTION 4: I suspect my child has sleep apnea, what should I do?
ANSWER: First of all, an ear, nose and throat examination should be done. The adenoids should be evaluated with endoscopic examination, and the size of the tonsils (tonsils) should be reviewed. If possible, the root of the tongue and larynx should also be examined in the endoscopic examination. If there is a suspicion of a developmental disorder in the facial skeletal structure, orthodontic examination should be performed, and the skeletal structure of the lower and upper jaws should be examined.
It is difficult to perform a sleep test in children, but if the physician evaluating the child wants to confirm the diagnosis, the adult sleep test can also be applied to children. It makes a significant contribution to the diagnosis in simpler methods than the sleep test; Recording the oxygen level during sleep and video recording of the child during respiratory events helps the physician.
QUESTION 5: How is sleep apnea treated in children?
ANSWER: Treatment is cause-oriented, weight loss if the child is overweight; If there are lower and/or upper jaw skeletal disorders, orthodontic treatment or skeletal surgery is applied. Sleep apnea in children is mostly related to adenotonsillar hypertrophy, namely adenoid and tonsil sizes. Removal of adenoid, removal or reduction of tonsils is the first treatment to be applied. In a small number of children whose complaints and apnea continue after adenoid-tonsil surgery, tongue root surgeries may come to the fore.
If children with overweight and lower and upper jaw skeletal disorders have adenoid-tonsillar enlargement at the same time, treatment is started with adenoid-tonsillar surgery.
There is no debate about the complete removal of the adenoid in a child with sleep apnea, and successful results are obtained by reducing the tonsils instead of removing them completely.
QUESTION 6: Will removing the tonsils harm my child?
ANSWER: There is no difference between children with and without tonsils. After the tonsil is removed, there is a temporary effect on the immune system for 3-4 months that will not affect the health of the child. In the long run, the immune system returns to normal. Removal of the tonsil does not create a predisposition to other diseases that may occur in the child. Partial removal or reduction of tonsils, which has been applied more frequently in recent years, can be preferred especially in children who have been operated for sleep apnea.
QUESTION 7: Is it true that adenoids get smaller with advancing age?
ANSWER: The adenoid becomes noticeably smaller after the age of 12-13, but the purpose of adenoid and tonsil surgeries is to prevent the damage caused by sleep apnea in children. When it is expected until the age of 12-13, it is highly likely that there will be growth-development retardation, development of heart diseases, and developmental problems in the facial skeleton. In addition, behavioral disorders and course failures can cause significant social problems in the child. If adenoid and tonsil size is diagnosed and associated with sleep apnea, surgical treatment should not be waited for a long time.
QUESTION 8: I had my child's adenoid and tonsil removed, but snoring and apnea complaints continue; what should I do?
ANSWER: If the complaints persist after adenoid and tonsil surgery, the otolaryngologist should reevaluate the child. Insufficient removal of the adenoids and insufficient reduction of the tonsils if the tonsils are partially removed may lead to the continuation of the complaints. Extremely large root of the tongue, loose structure of the pharynx and closure of the airway can be seen, albeit rarely.
When no tissue obstructing the airway is observed, orthodontic measurements are required by the dentist to evaluate the tooth and jaw structure and orthodontic treatment is required if necessary. A number of exercises that strengthen the mouth and tongue muscles are also very useful.
If sleep apnea continues despite all this, the use of devices that continuously pressurize the airway, called PAP, comes to the fore.
QUESTION 9: Why are tonsil surgeries performed other than sleep apnea or snoring?
ANSWER: Today, apnea and snoring are the most common reasons for tonsil surgeries.Frequent tonsillitis, chronic infection in the tonsils, protecting children from infections with high fever in some cases, suspicion of a tumoral disease in the tonsils are the first reasons for tonsil surgery.
QUESTION 1: I have nasal congestion for a long time, what are the causes?
ANSWER: If nasal congestion is long-lasting, there is either an anatomical cause affecting the cartilage and bone structure, or there is a chronic inflammatory disease that causes edema of the soft tissues in the nose.
Septum deviations (curvature of the cartilage-bone wall separating the two nasal passages), nasal valve problems (structural disorders-insufficiency of the cartilage forming the roof of the nose), turbinate hypertrophies (nasal meatus sizes) can be counted among the anatomical causes. Nasal polyps, allergic nasal diseases, and chronic sinusitis are the most common inflammatory diseases.
The treatment of anatomical obstructions is surgical, while drug treatments and surgical treatments are applied in inflammatory diseases. If nasal polyps and chronic sinusitis do not respond to drug therapy, surgical treatment should be considered.
Space-occupying masses and tumors in the nose should be considered in the differential diagnosis as a cause of long-term obstruction.
If you have long-term nasal congestion, an ear, nose and throat examination is a must.
QUESTION 2: What kind of complaints does “allergic rhinitis” (allergic rhinitis) cause?
ANSWER: Sneezing attacks, runny nose, nasal congestion, itching in the nose and nasal passages are the main symptoms of allergic rhinitis. Nasal discharge is usually clear and sticky. Allergic rhinitis can be seasonal or continuous. The treatment is arranged by considering the findings of the examination and the severity of the patient's complaints.
QUESTION 3: My nose is bleeding very often, what should I do?
ANSWER: Hypertension, use of drugs that prevent coagulation, diseases that predispose to bleeding should be questioned. The otolaryngologist should perform a detailed endoscopic examination, foci and diseases that may cause bleeding in the nose should be investigated.
QUESTION 4: What are the polyps on my nose, would you recommend surgery for the treatment?
ANSWER: Polyp is an abnormal response of the tissue called mucosa lining the nose to any external factor. Generally, when the nasal polyp is mentioned, a disease called "nasal polyposis" is understood. In nasal polyposis, sinus and nasal mucosa as a result of a genetic predisposition; It is sensitive to infections, fungal colonization, traumas and similar factors. This sensitivity causes excessive edematous flesh growths, which we call polyps, in the mucosa. Both nasal passages are occupied by polyps.
Not all nasal polyps are nasal polyposis; Unilateral “antrochoanal polyps” can be seen especially at younger ages. Unilateral nasal polyps can be a part of neoplastic (tumoral) diseases. Even though polyps called "inverted papilloma", which we encounter unilaterally, are benign tumors, they should be treated carefully because of their high recurrence rate and cancerous potential.
Polyps cause complaints such as nasal congestion, olfactory disorders, runny nose, facial fullness-pain. Detailed ENT examination and radiological examinations are absolutely necessary. Unilateral polyps almost always require surgery. This surgery provides both the reduction of the patient's complaints by removing the polyp and the collection of a sample for pathological examination. If the condition we want to treat is "nasal polyposis", there are different approaches among ENT doctors. One group of physicians adopts direct surgery followed by drug therapy, while another group follows the patients with drug therapy and performs surgery if necessary. Personally, I depend on the treatment in nasal polyposis, the size of the polyps, the severity of the patient's complaints,
QUESTION 5: How to understand whether there is sinusitis?
ANSWER: Complaints such as headache, postnasal drip, cough, facial fullness-pain, nasal congestion usually suggest sinusitis, but these complaints must be supported by physical examination findings or radiological examinations for a definitive diagnosis.
QUESTION 6: When do you recommend surgery for sinusitis?
ANSWER: If the signs and symptoms of sinusitis are present for a long time, the disease is considered to be chronic. Surgery may be considered in chronic sinusitis unresponsive to treatment. In addition, if there are anatomical disorders that predispose to the development of sinusitis, surgical interventions for these disorders are beneficial.
Rarely, sinusitis; It may spread to neighboring tissues such as the eye, brain, and in such a case, emergency surgery may be necessary.
QUESTION 7: I constantly use nasal spray for my nasal congestion; will it harm me?
ANSWER: Absolutely. Nasal opening sprays begin to damage the nasal mucosa after 5-7 days. If you need constant spray, you must have an ENT examination, the problem is permanent treatment for the cause of nasal congestion.
QUESTION 8: I want to have aesthetic nose surgery, I have nasal congestion, can I have both surgeries at the same time?
ANSWER: We strongly recommend that you have both surgeries at the same time. In aesthetic nose surgery, pieces of the septum cartilage in your nose are usually taken in order to shape your nose. If you have septum deviation, that is, cartilage curvature causing obstruction; Excess cartilages taken to correct this curvature can be easily used in aesthetic interventions.
QUESTION 1: What is sleep apnea?
ANSWER: It is the decrease or cessation of breathing during sleep due to obstructions in the upper airway. If these respiratory events occur with a certain frequency, sleep apnea is mentioned.
QUESTION 2: What are the symptoms of sleep apnea?
ANSWER: Severe snoring, episodes of respiratory arrest during sleep, and daytime sleepiness are the main symptoms of this disease. In addition, complaints such as waking up tired in the morning, waking up with morning headaches, distraction, general reluctance and fatigue, waking up frequently at night, waking up with a feeling of suffocation are also quite common in this disease.
QUESTION 3: Is sleep apnea common?
ANSWER: It is a very common disease. It is seen in 4% of men and 2% of women. In recent studies, it has been reported that sleep apnea is seen at a relatively high rate of 10% in the population.
QUESTION 4: Is sleep apnea a dangerous disease?
ANSWER: It is quite dangerous, cessation or reduction of breathing during sleep leads to a decrease in blood oxygen level. The decrease and subsequent increase in oxygen level with apneas leads to changes in blood oxygen level during the night. These changes lead to the release of certain substances from the inner walls of the blood vessels and a predisposition to atherosclerosis occurs. Sleep apnea is closely related to cardiovascular diseases such as heart attack and stroke. In addition, frequent interruption of sleep and stimulation of the body due to apneas trigger hypertension and rhythm disorders. Sleep apnea and hypertension are closely related.
QUESTION 5: Why do sleep apnea patients wake up tired in the morning, why do they feel sleepy during the day?
ANSWER: Complete cessation or reduction of breathing during sleep leads to sleep interruptions. In these sleep interruptions, the person is not fully awake, but his sleep becomes shallow and electrophysiological awakening occurs in the brain. The more frequent the respiratory events, the more frequent the sleep interruptions. Sleep interruptions affect the quality of life extremely negatively, waking up tired in the morning and sleepiness during the day; It leads to losses in work efficiency and deterioration of social life. It is known that a significant portion of traffic accidents are associated with sleep apnea.
QUESTION 6: Who is at risk for sleep apnea?
ANSWER: It is well known that sleep apnea is more common in men and its incidence increases with advancing age. The most important risk factors for sleep apnea are obesity and being overweight.
QUESTION 7: I suspect that I or someone close to me has sleep apnea, what should I do?
ANSWER: As mentioned above, sleep apnea is a condition that negatively affects the quality of life and is closely related to cardiovascular diseases. Diagnosis is extremely important. In case of such a doubt, the relevant physician should be examined and the necessary tests should be performed. Since the disease is caused by obstructions in the upper airway, it is very important to evaluate the upper airway by an otolaryngologist. This evaluation is important for diagnosis as well as useful in determining the appropriate treatment method. The definitive diagnosis is reached by the "polysomnography" test, which is popularly known as the sleep test. In this examination, the patient is hospitalized for one night in the sleep laboratory, and many parameters such as respiration, blood oxygen level, heart rate and sleep stages are evaluated.
QUESTION 8: Can the sleep test be done at home?
ANSWER: The sleep test can be done at home. As accurate results can be obtained as the examinations made in the hospital and under the supervision of a technician.
QUESTION 8: How is the severity of sleep apnea determined?
ANSWER: In the polysomnography examination, respiratory events (apneas and hypopneas) experienced by the patient during the night are scored. The number of apnea-hypopneas per hour is defined as the apnea-hypopnea index (AHI). The higher the AHI, the more severe the disease. In addition, many parameters measured in the sleep test should be evaluated together and the severity of the disease should be decided as a result of detailed evaluation. Evaluation of the sleep test, analysis according to the patient's complaints, determination of the characteristics of sleep apnea, correct diagnosis and selection of the right treatment are extremely important and require experience.
QUESTION 1: What is sleep apnea?
ANSWER: It is the decrease or cessation of breathing during sleep due to obstructions in the upper airway. If these respiratory events occur with a certain frequency, sleep apnea is mentioned.
QUESTION 2: What are the symptoms of sleep apnea?
ANSWER: Severe snoring, episodes of respiratory arrest during sleep, and daytime sleepiness are the main symptoms of this disease. In addition, complaints such as waking up tired in the morning, waking up with morning headaches, distraction, general reluctance and fatigue, waking up frequently at night, waking up with a feeling of suffocation are also quite common in this disease.
QUESTION 3: Is sleep apnea common?
ANSWER: It is a very common disease. It is seen in 4% of men and 2% of women. In recent studies, it has been reported that sleep apnea is seen at a relatively high rate of 10% in the population.
QUESTION 4: Is sleep apnea a dangerous disease?
ANSWER: It is quite dangerous, cessation or reduction of breathing during sleep leads to a decrease in blood oxygen level. The decrease and subsequent increase in oxygen level with apneas leads to changes in blood oxygen level during the night. These changes lead to the release of certain substances from the inner walls of the blood vessels and a predisposition to atherosclerosis occurs. Sleep apnea is closely related to cardiovascular diseases such as heart attack and stroke. In addition, frequent interruption of sleep and stimulation of the body due to apneas trigger hypertension and rhythm disorders. Sleep apnea and hypertension are closely related.
QUESTION 5: Why do sleep apnea patients wake up tired in the morning, why do they feel sleepy during the day?
ANSWER: Complete cessation or reduction of breathing during sleep leads to sleep interruptions. In these sleep interruptions, the person is not fully awake, but his sleep becomes shallow and electrophysiological awakening occurs in the brain. The more frequent the respiratory events, the more frequent the sleep interruptions. Sleep interruptions affect the quality of life extremely negatively, waking up tired in the morning and sleepiness during the day; It leads to losses in work efficiency and deterioration of social life. It is known that a significant portion of traffic accidents are associated with sleep apnea.
QUESTION 6: Who is at risk for sleep apnea?
ANSWER: It is well known that sleep apnea is more common in men and its incidence increases with advancing age. The most important risk factors for sleep apnea are obesity and being overweight.
QUESTION 7: I suspect that I or someone close to me has sleep apnea, what should I do?
ANSWER: As mentioned above, sleep apnea is a condition that negatively affects the quality of life and is closely related to cardiovascular diseases. Diagnosis is extremely important. In case of such a doubt, the relevant physician should be examined and the necessary tests should be performed. Since the disease is caused by obstructions in the upper airway, it is very important to evaluate the upper airway by an otolaryngologist. This evaluation is important for diagnosis as well as useful in determining the appropriate treatment method. The definitive diagnosis is reached by the "polysomnography" test, which is popularly known as the sleep test. In this examination, the patient is hospitalized for one night in the sleep laboratory, and many parameters such as respiration, blood oxygen level, heart rate and sleep stages are evaluated.
QUESTION 8: Can the sleep test be done at home?
ANSWER: The sleep test can be done at home. As accurate results can be obtained as the examinations made in the hospital and under the supervision of a technician.
QUESTION 8: How is the severity of sleep apnea determined?
ANSWER: In the polysomnography examination, respiratory events (apneas and hypopneas) experienced by the patient during the night are scored. The number of apnea-hypopneas per hour is defined as the apnea-hypopnea index (AHI). The higher the AHI, the more severe the disease. In addition, many parameters measured in the sleep test should be evaluated together and the severity of the disease should be decided as a result of detailed evaluation. Evaluation of the sleep test, analysis according to the patient's complaints, determination of the characteristics of sleep apnea, correct diagnosis and selection of the right treatment are extremely important and require experience.
Sleep Apnea Surgical Treatment
QUESTION 1: How is sleep apnea treated?
ANSWER: It is possible to treat sleep apnea surgically or with non-surgical medical treatments. The most effective treatment of the disease is the application of positive airway pressure, known by the abbreviation PAP. In this treatment, the upper airway is kept open by giving compressed air through the patient's nose or mouth and nose with the help of a mask. The aim of surgical treatments is to prevent obstructions that cause respiratory events by expanding the upper airway at the level of the palate and tongue root.
QUESTION 2: Can everyone use PAP treatments?
ANSWER: Despite their effectiveness, PAP treatments, often called mask treatments, have significant disadvantages. Almost half of the patients recommended PAP treatment cannot use this treatment. Various reasons such as the feeling of suffocation, inability to fall asleep with a mask, and difficulty in breathing against pressure limit the use of PAP therapy. Another reason that negatively affects the use of PAP therapy is the necessity of using this treatment every night and for life. Many patients reject the idea of being dependent on a device for life, especially in younger patients, PAP usage rates are known to be low; Some of the patients who start using the device stop the treatment after a certain period of time. However, it should not be forgotten that PAP applications are the most effective treatment for sleep apnea.
QUESTION 3: Does nasal congestion interfere with PAP treatment?
ANSWER: In the treatment of PAP, compressed air is given to the patient through the nose, so it is essential that the patient's nose is healthy. ENT examination is essential before PAP treatment, even if patients do not have complaints. PAP therapy can be used more comfortably and effectively when the problems of patients with blocked nose for any reason are resolved.
QUESTION 4: Are surgical treatments successful in the treatment of sleep apnea?
ANSWER: Surgical treatments are definitely included in the treatment of sleep apnea. With surgical treatments, it is aimed to alleviate the severity of the disease, reduce the complaints and reduce the risk of cardiovascular disease. These goals are often achieved with appropriate surgical treatment. The success of surgical treatments largely depends on appropriate patient selection. The success rate is high when patients with a high probability of responding to surgical treatment are selected and correct surgical interventions are applied.
QUESTION 5: Is the same surgical treatment applied to every patient with sleep apnea?
ANSWER: The surgical treatment of sleep apnea is individual. The upper airway structure of each patient is different. The location and shape of the obstructions that lead to respiratory events differ from person to person. Naturally, it is not possible to obtain the same results in all patients with the same surgical methods.
QUESTION 6: How is the appropriate surgical treatment determined in a patient with sleep apnea?
ANSWER: Patients with sleep apnea undergo a detailed ENT examination, in which the entire upper airway (palate level, tongue root level) is evaluated by endoscopic methods. A number of special inspection methods can be applied to determine the areas where the blockage occurs. If a more detailed examination of the location and form of the obstruction is required, sleep endoscopy, that is, endoscopic examination while the patient is put to sleep with medication, can be applied.
QUESTION 7: What interventions does the surgical treatment of sleep apnea include?
ANSWER: We can group surgical interventions as “nose”, “palate level” and “tongue root level” surgeries.
The aim of nasal surgeries is to widen the patient's nasal passage and to remove obstructions. Septoplasty, nasal valve surgeries, endoscopic sinus surgeries can be applied when needed.
Palatal surgeries are generally classified under the title of "pharyngoplasty" surgery. Procedures such as removal of the tonsils, repositioning of the palate muscles, interventions for the uvula, some suturing techniques and enlargement-stretching of the palate are selected in various combinations according to the needs of the patient.
The aim of tongue root surgery is to reduce the excess tissues in the tongue root and to position the tongue root in a way that expands the airway. For this purpose, partial removal of the tongue root or surgery that will change the skeletal structure of the lower jaw can be applied.
QUESTION 8: Is high technology used in sleep apnea surgery?
ANSWER: High technology is frequently used in apnea surgery. Radiofrequency, coblator and robotic surgery applications have become indispensable in apnea surgery.
QUESTION 9: What else can be done in treatment other than PAP treatments and surgery?
ANSWER: It is possible to achieve very successful results when oral appliances that allow the lower jaw to be positioned forward and positional treatments that allow the patient to lie on their side are applied correctly.
Although intensive studies continue today, there is no drug treatment with proven efficacy yet. Weight loss bariatric surgeries are very useful in overweight or obese patients. Regardless of which surgical or non-surgical treatment is applied; It is beneficial to lose weight, quit smoking and alcohol use, and exercise regularly.
QUESTION 10: Do surgical treatments that change the skeletal structure work in sleep apnea disease?
ANSWER: Surgery in which the lower jaw or the lower and upper jaws are brought forward together is very effective in the treatment of sleep apnea. However, these surgeries are performed after a long and laborious preparation period. The application is much more difficult than the soft tissue surgeries mentioned above. Highly effective results can be achieved in selected patients.
