Sleep Disordered Breathing —Diagnosis and Treatment

Abstract

Sleep apnea syndrome (SAS) is a typical group of sleep disordered breathing. For the diagnosis of location and severity of sleep dyspnea, history taking from family, signs and symptoms, local and general physical findings including fiberoptic endoscopy, X-films of the profile upper airway, cephalometry, polysomnography were performed. Parameters we used for polysomnography were EEG, EOG, EMG, ECG, Sa02, tcPO2 & tcPCO2, in traesophageal pressure, mesopharyngel pressure, heart rate, and tidel volume. Based on the value of intraesophageal pressure, the patients were classified into 3 groups ; slight (16-20 cmH2O), moderate (21-40) and severe (over 40). These values corresponded well with the apnea index and the percentage of Sa. 02 drop. The patients with severe obstruction are candidates for surgery of any kind. The location of stenosis was evaluated by comparing the data of mesopharyngel and intraesophageal pressures ; mesopharynx 51%, base of tongue 31% and combined 18%. Treatment varies widely; conservative and surgical. For the patients with moderate obstruction, nasal CPAP, body weight reduction, medication of antibiotics or KANPO, mandibular prosthesis are used depend on their causes. For those with severe obstruction intranasal corrective surgeries, adenotomy and tonsillectomy, uvulopalatopharyngoplasty (UPPP), median partial glossectomy, tracheostomy are indicated depend on their causes. UPPP improved dyspnea definitely in 2/3 of the total. The remaining 1/3 were improved by median partial glossotomy. © 1992, The Society of Practical Otolaryngology. All rights reserved.