D.S. Deenadayal - Management of Snoring and Obstructive Sleep Apnea: A Practical Guide

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The event of snoring indicates some degrees of airway obstruction. While snoring indicates a partial airway obstruction, apnea indicates a complete airway obstruction.

Many OSA patients remain undiagnosed or remain reluctant to seek treatment for their condition as they are unaware of the newer treatment options available.

Obstructive sleep apnea (OSA) is characterized by episodes of partial or complete obstruction of the upper airway during sleep, thus interrupting (apnea) or reducing (hypopnea) the flow of air.

These cycles of apnea/hypopnea which repeat several times an hour, result in fragmented and disturbed sleep.

The upper airway, particularly the oropharynx and hypopharynx, is the region where most obstructive processes leading to OSA occur.

In the age group of 3035 years, around 20% of men and 5% of women snore. By the age of 60, this percentage increases to 60% in men and 40% in women [].

Snoring is three times more common in obese individuals [] and is a terrible marital and social problem.

OSAS has a negative impact on the health and behavior of millions of people throughout the world.

It is also an independent risk factor for many diseases, such as hypertension, heart failure, heart attack, cardiovascular events, and arrhythmias.

Today, sleep-disordered breathing is recognized as a distinct clinical entity that requires to be evaluated and treated.

In order to ensure the holistic treatment of a patient suffering from sleep-related disorders, different specialists, namely a pulmonologist, a neurologist, an orthodontist, and an otolaryngologist, are required to collaborate and work as a team.

Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late twentieth century.

In the early reports of the 50s, obstructive sleep apnea was termed as an uncommon disease. However, a few years later, in the 70s, hundreds of cases were reported. It was in 1975 that Carroll et al. described the differences between the Pickwickian syndrome and OSA [].

Thereafter, since the last two decades, there has been a paradigm shift in the diagnosis and management of OSA.

Until the early 2000s, the most common specialists who were involved in the treatment of SDB were a neurologist or a pulmonologist. Otolaryngologists played a small role in definitive treatment in sleep medicine. Since neurologists are trained to read an EEG, they could interpret the polysomnography data with ease and the pulmonologist displayed an expertise in the use of positive airway pressure therapy, thus making them the primary physicians in the area of sleep medicine until recent times.

Over the years, otolaryngologists have been trained for upper airway surgeries. However, they were still not considered primary physicians in sleep medicine and their opinion was sought only if surgical intervention was deemed necessary by the primary care physician.