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Snoring + OSAS Dave Pothier St Michaels Hospital 2004

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Definition Snoring is noisy breathing during sleep OSAS is upper airway obstruction during sleep

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What is it?

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Who snores? MenWomen Age 30 20%5% Age 60 60%40%

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How loud? Kra Walkert from Sweden: 93dB recorded at rebo Hospital, 24 May 1993

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Morbidity None to patient Many reports of shootings and GBH from partners of snorers Surgery almost entirely done for anothers benefit

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Who? Who snores: Facial abnormalities Micrognathia Overweight, thick neck, heavy drinkers Adenoids Who has OSAS: Snorers (end of spectrum) 5% of population 25% of hypertensives 50% of OSAS sufferers are hypertensive

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So NB to differentiate History Examination ??? Investigations

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Pickwickian syndrome Fat Boy Famous for daytime somnolence

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Hx Weight Alcohol Smoking Nasal symptoms

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Epworth score

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Examination Nose Nasendoscopy +/- Muller manoeuvre

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Investigations Sleep nasendoscopy Sleep studies

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Treatment of snoring Conservative Medical Surgical

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Treatment Conservative Stop all fun things in life - eating lots - drinking lots of beer - smoking VERY EFFECTIVE IN MOST CASES

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Treatment Medical - over the counter sprays - homeopathy? Mandibular splints Not good!

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Treatment Surgical OSAS largely contraindicated Snoring a myriad of operations

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Surgical options for snoring Nasal Palatal Tongue base

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Nasal surgery Septoplasty SMR ITs Adenoids/tonsils

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Tongue base surgery - not commonly perofmed Advancement procedures Partial glossectomy Maxillomandibular advancement

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Palatal surgery 1 Ensure all other causes eliminated Exclude OSAS Exclude nasal pathology

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Palatal surgery 2 -LAUP-UPPP -Coblation et al

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Effectiveness 80% immediate effect after recovery 30% at two years

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OSAS Medically treated with CPAP (almost 100% effective) (only 50% compliance)